Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Jessica Leano, Staff. Today's visit was conducted with Michael Custodio, Francis Martir, Administrator did not participate in today's visit due to a prior commitment. The reason for today's visit was provided.

The facility is a single storey building consisting of a kitchen, dining room, living room, 9 bedrooms of which 3 bedrooms located in the front are used for live-in staff, an attached garage and detached back house was previously rented and is currently vacant. A copy of the building permit was requested for the back house. The facility is fire-cleared for 3 AMBULATORY in bedroom #3 and bedroom #4, 2 NON-AMBULATORY in bedroom #1 and bedroom #2 and 1 BEDRIDDEN resident in bedroom #5. The home has an approved hospice waiver for 6 residents.

On today's visit the only domain reviewed on the CARE Inspection Tool was the Incidental Medical and Dental domain, 4 resident files and medications for Resident #2, Resident #3 and Resident #4 were reviewed. Resident #1's medication was not reviewed as the resident retains their own medications in their own room in a locked plastic box. The following was noted:

Residents #1, #2 and #4 have not received an annual medical assessment

Resident #3 does not have any evidence of a TB test

Resident #3 and Resident #4 are prescribed PRN medications but there were no completed PRN