Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Honesto Fernandez, Continual Administrator's Certification expires 03/30/2025. There are currently 6 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.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 105 degrees. Toxins and cleaning supplies are locked and inaccessible.

LPA Hurt observed the facility temperature below 64 degrees. LPA Hurt observed the hallway bathroom door is in disrepair and does not lock. LPA observed the facility resident bedroom trashes with no lids. LPA observed the facility bathroom has shared hand towels. LPA observed the facilities fire extinguisher has not been serviced within the last 12 months. The facility does not have an Infection Control Plan. The facilities first aid kit is not complete. LPA observed window screen on left side of facility ripped and in disrepair. LPA observed front resident bedroom dresser drawers to be in disrepair.

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-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, Honesto Fernandez and copy of report left at facility