Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. visit of the facility. LPA was welcomed by Administrator/Licensee Pilar. There is a total of 2 residents, none have a diagnostic of dementia and no residents currently on Hospice.

LPA toured the facility on 10/12/2023 at 9:10 AM with Pilar - licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 4/11/2023 at the time of the visit. Smoke detectors and carbon monoxide detector were found to be operational during the visit. Hot water temperature measured between 115 degrees F and 115.3 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility on 10/12/2023. The facility serves residents with dementia and has a plan of operation for special care and programming. 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 a locked hallway closet. The bathrooms designated for residents at the facility were supplied with 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. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 10/12/2023.

A review of two resident & three staff records and licensee/administrator as well as two resident’s medications was conducted. LPA reviewed resident’s files at 10:00 AM on 10/12/2023 and learned that 2 of 2 residents have updated appraisals/needs & care plans and physician’s assessment (LIC 602A).

Medications were centrally stored in locked cabinet in the facility kitchen area, although some were pre-poured (TV given). The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 10/12/2023. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete.