Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an annual required visit. LPA met with Licensee Richard Rabena and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed 5 residents' medications and observed food supply. Facility has submitted a mitigation plan and is approved.

LPA inspected all bedrooms, bathrooms, dining and living room. Facility has a main entry point for screening. Each bedroom has a chair, bed, linen, dresser, light, sufficient closet space and required furniture and equipment. All bathrooms were toured and the toilets, hand washing and showers are safe and sanitary. The food in the kitchen has sufficient supply of 2 days perishable and 7 days non-perishable. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The backyard has a shaded area and sitting area. Medications are centrally stored, locked along with the records. Resident medication logs and medication were reviewed along with emergency contact information. Smoke alarm and Carbon monoxide detectors were inspected and seem to be operational. The facility has (3) fire extinguisher that are within the required operable range and sprinkler system installed.

The hot water temperature measured between 116.9– 118.7 degrees F. Drano solution was unlocked in bathroom #1 accessible to residents. Some PRN medications lacked labels and PRN letters.

Deficiencies cited under California Code of Regulations Title 22

An exit Interview was conducted with the Licensee's and a hardcopy was provided. Appeal Rights was provided.