Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with the administrator, Flordeliza Sasada, and explained the purpose of the visit. The facility is licensed for six (6) residents, ages 60 and over, of which six (6) may be non-ambulatory and one (1) bedridden approved for bedroom #3. There is a hospice waiver approved for (1) resident.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility has 4 bedrooms (3 shared resident bedrooms, 1 staff room), 2 bathrooms, living room, dining room, kitchen, and detached garage. The backyard has a covered area with tables and chairs. The swimming pool is surrounded by a fence. There are no items obstructing the walkways. Smoke and carbon monoxide combo detectors are connected to the fire department. Facility has fire sprinklers. LPA observed sufficient food supplies of perishable and nonperishable. Knives and cleaning solutions are locked and inaccessible to the residents. The hot water temperature is measured within the required range of 105-120 degrees F.

LPA reviewed (3) personnel files. Administrator's certificate expires on 1/31/28. Staff are receiving training and has current CPR certificates. LPA reviewed five (5) resident files, and the files contain the physician's report and TB test results or chest xray, consent forms, admission agreement, and resident rights. The medication are centrally stored and administering to residents as prescribed. The current Emergency Disaster Plan is in place. LPA issued technical violations for disaster drills, staff training, and resident reappraisals.

No deficiencies issued today. An exit interview was held and a copy of this report, along with appeal rights, was given to the administrator.