Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility staff Richard Macasaet, Continual Administrator's Certification expires for Administrator Jose Vitan expires on 12/26/2026. There are currently 18 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. 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. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

Water temperature in men's bathroom was tested at 135 degrees. LPA observed a large hole behind ladies room sink, and shower tiles missing leaving large holes inside men's room shower. This facility does not have current fire clearance. LPA observed tears in facility window screens. LPA observed Staff 1 does not have file available review. Staff 2 does not have required health screening. Resident 1 does not have completed Restricted Health care plan. The facility staff files do not have required initial training. The facility is not conducting required disaster drills (last drill 01/2025.) Resident 2 does not have updated Needs and services plan or Medical Assessment (over age 60). LPA observed a washing machine inside resident bedroom. The facilities Emergency Disaster plan is not detailed. The facility Infection Control Lead does not have required training, and the staff is not trained on the Infection Control Plan. The facility does not have sugar free foods for multiple residents including resident 2 that require a diabetic diet. Resident 3 does not have required medical assessment.

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 Facility staff Richard Macasaet, and copy of report left at facility