Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Gabriela Garcia and explained the purpose for today’s visit. The facility is licensed to serve (6) Bedridden Residents (in rooms 2,3,4) and (1) Ambulatory Resident Ages 59 and over. There is an approved Hospice waiver for (6). The facility currently has (0) Residents.

The facility is a single story home located in South Gate, Ca. A tour of the facility includes: 4 bedrooms, 2 bathrooms (1 of which is inside room #4), living room, dining room, kitchen, laundry area, den, front yard back yard and detached garage.

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

Physical Plant & Environment Safety: LPA toured facility, resident bedrooms have closet/drawer space to accommodate each resident. Passageways are free of obstruction. No bodies of water were observed at the facility. All storage areas for cleaning solutions, toxins, knives, and hazardous items have a designated locked area that is inaccessible (locked kitchen cabinet). Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Facility has alarms on all door that lead to exterior and call buttons that are operable. Food Service: The kitchen was observed for the ability to prepare and serve food. Operational Requirements & Staffing & Personnel Records-Training : There are currently no staff due to no residents, however, administrator is aware of the required training and fingerprint clearance that staff must complete prior to working with residents. Administrator Gabriela Garcia has a current administrator certificate expires 5/29/2027. Resident Rights-Information & Resident Records-Incident Reports: Internet and Telephone are connected and readily available for use. Resident rights/reporting posters are displayed within the facility. There is a designated area where resident files will be maintained within a locked cabinet. Disaster Preparedness: The facility has an Emergency Disaster Plan and Infection control plan.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was emailed.