Facility Evaluation Report

On 1/30/25 an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Mercedita Malano, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. Shortly after the Administrator, Elaine Bote arrived and helped with physical plant tour and staff/residents’ files.

During today's visit, LPA conducted a physical plant walk through at approximately 11:00am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.

The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and of which fire clearance approved for two (2) Bedridden. Facility also has a hospice waiver for one (1) resident. There are four (4) bedrooms in the facility and all bedrooms are designated for residents’ use. Bedrooms observed to be appropriately furnished. LPA observed rooms to have clean bedding sheets, pillowcase, blankets, mattress pads, which are in good condition. All bedrooms have appropriate lighting. LPA observed obstruction in front of the exit door in bedroom #4. There are three (3) bathrooms in the facility of which two (2) are designated for residents’ use and one (1) for staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 11:30 to be 118°F. Extra towels and linens were readily available inside the linen cabinet located in the hallway. 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.

LPA observed facility alarms were present on all exit doors and all the signals were functional.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 12:00pm they were tested and observed to be operational. The facility has one (1) fire extinguisher located in the kitchen that was last purchased on January 1st, 2025.