Facility Evaluation Report

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection visit. LPA was greeted by staff and explained the purpose of the visit.

The facility is licensed to serve six (6) residents age range 60 and over of which five (5) can be non-ambulatory and one (1) bedridden. Hospice waiver in place for six (6) residents. There are currently five (5) residents in care, of which two (2) are receiving hospice services and one (1) resident is bedridden. The facility in operating within the limitations of there license.

The facility is a single-story home located in a residential area of San Dimas. The home consists of a living room, kitchen, dining area, family room, four (4) resident bedrooms, two (2) bathrooms, attached garage with laundry, front and back yards.

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

Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Gonzalez observed combination carbon monoxide/smoke detectors in hallways. Four (4) resident rooms were observed to contain required furniture, linens and lighting, all in good repair. LPA observed grab bars near toilets and inside shower as well as no-slip coating on shower floors. Passageways and exits are clear of obstructions. Continued on LIC809C