Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to conduct a health and safety check for the residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 12:30pm. LPA met with Administrator (AD) Heddy "Girlie" Mae Oyson and explained the purpose of the visit. The facility currently has five residents in care.

LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. All utilities were in working order and appliances were operational. A grocery delivery was expected to arrive today. While touring the facility, LPA conducted a health and safety check for five of five residents in care. Three of five residents were napping after eating lunch. Two of five residents were interviewed and stated they did not have any issues and that everything was fine. LPA interviewed three of three staff members regarding care provided or any issues with the facility.

LPA obtained copies of the resident and staff rosters and the following documents from five of five residents' records: Identification and Emergency Information forms (LIC 601), Physician's Reports (LIC 602A), Resident Appraisals (LIC 603A), hospice paperwork and Admissions Agreements. Records were taken by the LPA for copying since the facility copier was not in working order at time of visit.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Heddy "Girlie" Mae Oyson, Administrator and a copy of the report was given at the time of the visit.