Facility Evaluation Report

At approximately 10:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and was greeted by Theresa May Jones, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with twenty-four (24) residents in care, all of whom are assisted living residents. Facility has a Hospice waiver for four (4).

At approximately 10:45 AM, LPA began file review. Five (5) staff files were reviewed and each contained the required documents per regulation. All staff files reviewed contained proof of current First Aid and CPR training. Four (4) of five (5) staff files reviewed were deficient in some or all of the required initial and annual training, (see LIC809D).

At approximately 11:30 AM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Appeal rights were provided. Exit interview conducted with Administrator whose signature on form confirms receipt.