Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced annual inspection visit. LPA was allowed entry by Maria Teresa Cerino. LPA spoke to Rocio Collado via telephone and discussed the purpose of today’s visit.

This facility consists of (6) bedrooms, (1) staff/employee room, (3) full bathrooms, (1) ½ bathroom, utility room (laundry), living room, dining room, kitchen. This facility is currently approved for (12) AMBULATORY residents only. Per Ms. Collado, this facility will only be able to accommodate up to (9) residents and not (12) residents. This facility has not admitted any residents since becoming licensed.

The following was discussed during the telephone call with Ms. Collado:

Change in capacity- Ms. Collado was instructed to submit a new LIC 200/Application, facility sketch and a check to CDSS for the request of change in capacity. The new LIC 200 and facility sketch is to identify/reflect the total number of beds (including non-ambulatory).

Request for non-ambulatory- Per Ms. Collado, there is an inspection pending with the Fire Department to move forward with this request. Ms. Collado will provide updates to LPA. Additionally, LPA briefly discussed dementia plan as potential residents with this diagnoses are considered to be non-ambulatory. This facility does not have a dementia plan in place.

Refer to LIC 809C for the continuation of this report.