Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator, Jose Vitan Continual Administrator's Certification expires 12/26/2024. There are currently 22 residents living at this facility. 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. 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.Toxins and cleaning supplies are locked and inaccessible. The facilities emergency disaster plan is not current. LPA Hurt observed several resident dressers broken and in disrepair. LPA Hurt observed several resident mattresses in disrepair including box

springs to be very dirty. LPA Hurt observed a facility resident bathroom toilet broken, and in disrepair. LPA Hurt observed the facility bathroom to be dirty, and in disrepair. LPA Hurt observed several LPA Hurt observed Resident 1 approach facility staff and request the shower be "unlocked" so she can use. LPA Hurt observed several facility window screens in disrepair. LPA Hurt observed an expired food (condiment) in the facility food supply, and several items that should be refrigerated being kept at room temperature. The facility does not have a complete first aid kit.

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 Administrator, Jose Vitan and copy of report left at facility