Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Gaudiosa Cauntay Continual Administrator's Certification expires 03/05/2027. There are currently 7 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, 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. First Aid kit is on site and complete.

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 reviewed facility Infection Control Plan, and facility Emergency Disaster Plan.

Water temperature was tested at 100 degrees in bathroom closest to facility entrance, and 130 degrees in bathroom in hallway furthest from entrance. LPA observed expired foods in facility refrigerator bottom drawer. LPA observed the facility outside and inside has a lot of clutter. LPA observed the facility shower head is dirty. Licensee closed facility #275200997 and moved all residents to this facility April 1, 2025 without notifying Licensing. Resident 1 does not have medical assessment on file. Resident 2 does not have Admission agreement on file. Staff 1 does not have required Health Screening LIC 503. Resident 2 does not have his cash resource ledger completed. LPA observed bleach under kitchen sink accessible to residents. LPA observed facility hallways leading to restrooms do not have required lighting.

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

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-D 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 Licensee, Gaudiosa Cauntay, and copy of report left at facility