Facility Evaluation Report

On 06/05/25, LPA Vaid conducted partial annual at the facility due to insufficient time. Today LPA Vaid will complete the remaining domains of the CARE tool.

Met with Stephanie Cordova-med aid and Administrator Rosalie Sandoval explained the reason for the visit. LPA Vaid and staff Cordova toured the facility and did not observe any health and safety concerns.

The facility is licensed to serve 40 non-ambulatory residents ages 60 and over with an approved hospice waiver for 5 residents. The facility is a 2-story building located in a residential area, it has 20 shared rooms, an activity room, a dining room with kitchenette, a medication room, a cover balcony on the second floor, and a back outdoor area.

Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for S-1 through Staff #4 (S1-S4). Staff have their Health Screening and Tuberculosis Screening on file. First Aid /CPR Certifications and clearance are observed.

Incidental M&D: The medications are centrally stored in the medication room and in bubble packs and/or original containers. Medications are administered as prescribed by the Physicians’ order.

Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #4(R-4). Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Functional Capabilities, ALW assessment and Resident Rights were observed.

Clients with SHN : Facility does not use manual restraints at this facility.

No deficiencies were noted on today’s visit. Exit interview was conducted with Rosalie Sandoval administrator and a copy of this report, were provided.