Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt and Brianna Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator, Ahluwalia Surinder, Continual Administrator's Certification expires 01/13/2027. There are currently 3 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. First Aid kit is on site and complete.

LPA's observed one facility window screen with small tear. LPA's observed Resident 1's Centrally stored medication record is not accurate. Water temperature in facility hallway bathroom was tested at 110 degrees. Water temperature in Resident 2's bedroom measured to be 126 degrees. Resident 1 and Resident 3's Appraisal/ Needs and services plan is not updated annually. LPA's observed the exit in Resident 2's bedroom is locked and leads to a staff room. The staff room is not listed on the facility sketch. LPA's observed over the counter medications above in a cabinet unlocked above the facility refrigerator. LPA's observed all purpose cleaner unlocked and accessible under facility kitchen sink. Facilities Infection Control Plan, and Emergency Disaster Plan are not signed as reviewed annually.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Administrator, Ahluwalia Surinder, and copy of report left at facility