Facility Evaluation Report

An unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan on 8/19/24 at 9:45 am. Upon arrival LPA met with Estela Monderin the facility Administrator, who granted access to the facility. LPA explained the reason for the visit. Shortly after the Co-Administrator , Tajdari Daisy Shirin 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 five (5) residents, of which five (5) may be Non-Ambulatory. Facility also has a hospice waiver for five (5) residents. There are four (4) bedrooms 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 106°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 hallway area. PRN medications have

written orders from a physician. The facility serves residents with dementia. Potentially dangerous items are kept inaccessible to residents with dementia. There is staff to meet the needs of residents with dementia. Facility has 2 staff for AM shift and 1 awake caregiver for PM shift.