Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Assistant Administrator, Maria Luisa Razo and discussed the purpose of the visit. The facility is licensed to care for elderly residents age range 60 and over, 97 non-ambulato ry, of which 30 may be bedridden and a hospice waiver for 30 has been approved.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an updated Infection Control Plan. Staff are adhering to infection control requirements.

Operational Requirements: Hospice Waiver for 30 is approved. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires on 02/01/2026. Surety bond in the amount of $10,000 is current.

Physical Plant/Environment Safety: The facility is a single story building which consist of reception area, large dining area, forty nine (49) resident bedrooms, administration office, business office, medication room, kitchen, storage room, cooler, electrical room, conference room, janitor's room, salon and outdoor seating/smoking areas. The interior and exterior physical plant was inspected. Kitchen was inspected, knives, cleaning solutions, and disinfectants are locked and inaccessible to residents. LPA toured random resident rooms which were newly painted and observed each bedroom to contain the required furniture and linens. Bathrooms were observed to be clean. The signal system was tested in various locations and is operable. The fire extinguishers were observed to be fully charged and in compliance. Exit doors are free of any obstruction and there are no pools or large bodies of water. There are no security bars or weapons on the premises. Cleaning supplies and toxic substances are inaccessible to residents. LPA tested hot water temperature in eight (8) random rooms (#4, #6, #17, #18, #37, #39, #40, #42) and the readings vary between 84 deg F to 123 deg F which did not meet the required 105 - 120 deg F stated in Title 22 regulations. *****CONTINUED ON LIC809-C****