Facility Evaluation Report

An unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena

Khurshudyan on 9/13/24 at 10:00 am. Upon arrival LPA met with Mario Resurreccion Caregiver, who

granted access to the facility. LPA explained the reason for the visit. Shortly after the Administrator , Madonna Olila arrived and helped with physical plant tour and staff/residents files.

During today's visit, LPA conducted a physical plant walk through, at approximately 10:20am, to ensure that

the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.

Facility is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory, one (1) can be Bedridden. Facility also has a hospice waiver for two (2) residents. This is a single story house. There are five (5) bedrooms in the facility of which four (4) is designated for residents’ use. Bedrooms are appropriately furnished and have appropriate lighting. There are two (2) bathrooms in the facility. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 10:45 to be 109°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. The facility has alarms on all exit doors. Centrally stored medications are locked in the cabinets located in the kitchen. PRN medications have written orders from a physician. The facility has dementia care plan. however, currently they don't have dementia residents.

Facility has 2 staff for AM shift and 1 awake caregiver for PM shift.