Facility Evaluation Report

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to continue a Required-1 Year inspection and review staff and resident records. LPA met with Administrator Genaro Gonzalez and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 6 residents. At approximately 8:40AM, LPA reviewed 6 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. LPA discussed with Administrator the value of being more detailed when conducting the Reappraisals to ensure person centered care. Documentation of a medical assessment made within the last 12 months or a signed declination were present. At approximately 9:40AM, LPA conducted a review of medications. Medication is locked and not accessible. First aid kit was present. At approximately 9:50AM, LPA reviewed 6 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. Facility did not have documentation of a completed emergency drill within the last 3 months. Evidence of Liability insurance received during this visit.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Genaro Gonzalez and Appeal rights were given.