Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with House Manager, Terry Lacey Continual Administrator's Certification for Lidia Silveira expires 10/04/2026. There are currently 4 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. 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 and performs disaster drills as required.

LPA observed spider webs in corners, and furniture needs dusting. LPA observed chemicals inside garage accessible to residents. Staff 1 does not have required training. Resident 1 does not have updated Needs and services plan. The facilities Plan of Operation does not have a required mention of dementia. The facility residents do not have planned activities. LPA observed a large bed located inside resident common area. Resident 2's medications are not logged into the Centrally Stored Medication record. First aid kit is missing the tweezers.

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 House Manager, Terry Lacey, and copy of report left at facility