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 12/26/2026. There are currently 23 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, dining area, 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. 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 observed several light fixtures with no covers. LPA observed the facility has loose electrical outlet coverings throughout the facility. LPA observed several vent covers to be dusty and loose. LPA observed dust and webs in several corners and areas throughout the facility. LPA observed several toilet tanks do not have lid/covering. LPA observed several resident dressers in disrepair. LPA observed bedroom nigh stands with no lamp (required furnishing.) LPA observed several facility window screens.

LPA observed the water in all besides one facility bathroom (front ladies bathroom next to office) measured to be over 120 degrees. Resident 1 missed two medications on 03/03/25, and 03/10/2025 that were not documented. The facility staff signed the MAR on 03/10/2024 documenting medication was given to Resident 1. LPA observed several residents with no pre admission assessments in files. Residents do not have LIC621 Safeguard for personal property and valuables forms in files. The facility program plan is not available for review. Staff 1, Staff 2, Staff 3, and Staff 4 does not have required LIC503 Health Screening Report. Facility staff did not have required training in files. The facility has residents that require a special diet.

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