Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility. LPA was welcomed by front desk staff who directed LPA to sanitize hands, screen for symptoms, and sign-in on the visitor sheet. Front desk contacted Resident Care Director Loata Taole for the visit. There are 33 residents in care at the facility with 7 on Hospice.

At approximately 9:45 am on 5/26/2022, Interim Executive Director, Tony Ibarra arrived at the facility and began the inspection. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 11/4/2021 at the time of the visit. Fire sprinkler system (Matrix) which is connected with smoke and carbon monoxide detectors was last inspected on 1/18/2022. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in the laundry room cabinet on the first floor. However, Lysol was found in an unlocked cabinet on the second floor kitchenette accessible to residents, along with nail polish remover in R1’s night stand (see pictures, LIC 809-D), which were removed by Administrator during inspection. Dangerous items are kept in the main kitchen or locked in the medication room. However, R2 had a box of razors, nail clippers, and scissors in his bathroom (see pictures, LIC 809-D). All resident’s bedrooms have lighting & appropriate furnishings. In 7 out of 9 residents bathroom faucets hot water temperature measured between 121.8 degrees F and 124.5 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees (see LIC 809-D). Administrator contacted facility service vendor during tour to adjust the water temperature today. Residents’ medications are centrally stored and locked in the medication room on the second floor. Facility has a 30-day supply of medication for residents.