Facility Evaluation Report

Licensing Prog ram Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry after explaining the purpose of the visit. Administrator (AD) Dolores Benedicto assisted with the inspection. LPA observed the Administrator certificate was current with an expiration date of January 13, 2027 . This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for six. The facility is a one-story home with four resident bedrooms , four staff rooms one of which is labeled as a staff rest area, one resident bathroom, 2 staff bathrooms, a family room, living room, kitchen, dining room, bar, and an attached garage with an exterior entrance.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPA observed residents sitting at the dinning table in the dining room and resting in their respective bedrooms. LPA observed four residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the dining room. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed bathrooms were clean and equipped with grab bars and non skid floors. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 110.6 and 113 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use.