Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee Aida Fernandez Continual Administrator's Certification for Administrator / Licensee Honesto Fernandez expires 03/30/2027. There are currently 3 residents who reside at this home. 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. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA reviewed facilities Infection Control Plan. Emergency Infection .Control Plan. resident files, and staff files. The facility does not have a Plan of Operation available for review. Water temperature measured to be 104 degrees. (below the required minimum.) Some areas of the facility (vents, light fixtures) appeared to be dusty.

Resident 1's Physician's report is not complete (administer medications section.) Resident 2's Physician report is not accurate.

There were no 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-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 Licensee, Aida Fernandez and copy of report left at facility