Facility Evaluation Report

License Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by staff June Gallen Mateo & Mariel De Vera. Ana De Ventura – Administrator/Licensee was contacted by staff and arrived during the visit. There is a total of 6 residents and 4 with a diagnostic of dementia. There are 2 residents currently on Hospice.

LPA toured the facility on 8/24/2023 at 8:55 AM with staff June Gallen Mateo; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices; 4 out of 5 auditory devices were missing and one was falling down. Exiting could present a hazard should residents exit facility unattended (see LIC809-D). Fire Extinguisher was found to be last charged on 6/20/2023 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 118.2 degrees F and 130.1 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 1 of 2 resident’s bathrooms while touring facility on 8/24/2023 at 9:10am (see LIC 809-D). The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food 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 garage, however; garage knob lock is facing the kitchen and can be unlocked without any key or device and sharp scissors were left on counter & in unlocked kitchen drawer. Facility has 4 residents with a diagnostic of dementia. (see LIC 809-D) There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers.

Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Facility understands that resident’s beds must be outfitted with mattress pads as required by Title 22 Regulations # 87307 unless residents refuse - mattress pads must be available at the facility on 8/24/2023. Continue LIC 809-C