Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA discovered there was no one present. LPA called facility phone number and shortly after Staff member / Medical Coordinator/ Martha Ramos arrived and later Wendy Vasquez/ DSP Supervisor arrived at the facility and assisted with the visit.

The facility is licensed to serve six (6) Non-ambulatory Residents ages 60 and over. The facility is vendored with the San Gabriel/ Pomona Regional Center, level RCFE 4C.

LPA used CARE Inspection tool to conduct todays visit, a tour of the physical plant was conducted alongside with Martha Ramos, medication was reviewed with Wendy Vasquez, staff and resident file review and staff interviews were conducted. No resident's present during visit therefore no resident interviews were conducted.

The facility is located in a residential area. A tour of the single-story facility includes: (3) resident bedrooms, (2.5) resident bathrooms, living room/ office area, dining room, kitchen, laundry room/ pantry, (2) backyards observed and no large body of waters observed.

Kitchen and food supply was observed, operable equipment and thermometers in place for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables, facility has a pantry with food supplies. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to clients. Kitchen Cabinets a total of two drawers are not on track, un-leveled and not sturdy, deficiency noted.

There is a functioning telephone and internet on the premises. Continuation 809-C...