Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced required annual visit and was greeted by the Administrator Mary Ann De Lima. LPA Spaeth observed there were two caregivers providing care to the residents. LPA Spaeth confirmed there are five residents. The facility is licensed as an RCFE to serve six residents of which six may be non-ambulatory and two may be bedridden. There is a hospice waiver. LPA confirmed the facility phone number is 661-526-4322.

LPA Spaeth and the Administrator toured the facility at 10:00 am until 10:40 am. LPA Spaeth observed the facility was neat and clean.

Kitchen – LPA observed a seven-day supply of non-perishable food and a two day supply of perishable food items. LPA observed the cleaning supplies were securely locked underneath the kitchen sink and the knives were locked in a kitchen drawer. The medications are locked in a kitchen cabinet and LPA also observed the first aide kit. A fire extinguisher is also located in the kitchen area.

Backyard – LPA Spaeth observed the delayed egress alarm leading out of the sliding glass door to the backyard was properly working. The backyard is a shaded area which contained comfortable seating. The side gate leading from the backyard to the front yard was not locked.

Bedrooms – LPA Spaeth observed there is one resident living in the master bedroom. The delayed egress alarm leading from the bedroom to the backyard was properly working. The room contained bed, linens, night stand, and night lamp. LPA also observed the other three bedrooms also contained the required bed,