Facility Evaluation Report

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Stacy Santana Lopez, Manager, and the visit for the visit was explained. Linda Morales, Administrator, arrived thereafter.

The facility is licensed to serve (6) non-ambulatory residents; Hospice approved for (1) resident. Facility is operating within the scope of its license. The facility is in a residential area of Pasadena and it consists of living room, dining room, kitchen, five resident bedrooms, (1) full and (1) half bathroom, laundry/supply room and front and back yard.

During today's visit, the following was observed:

Facility is clean and walkways, ramps and staircases are free of debris and obstructions. Furniture throughout the facility is in good repair. There is sufficient seating in the living and dining room for residents. Bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Extra linen is kept in hallway closet.

Kitchen appliances are clean and were operating at the time of visit. Sharps and cleaning supplies are kept locked inaccessible to residents. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed.

Bathrooms were inspected and were observed clean and sanitary. Shower in main bathroom has grab-bars and anti-slip mats. Water temperature was tested in both bathrooms and measured within the required 105 - 120 degrees F. Sufficient personal hygiene supplies for residents are kept in the laundry room. ***Continues on LIC 809-C***