Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Fernan David and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. LPA and Administrator toured the facility. The facility has 6 bedrooms, 2 are for staff and 4 for residents, 2 bathrooms, kitchen, dining room, living room and a two car garage. LPA observed there is a table and chairs with an umbrella in the backyard. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked in a kitchen drawer. Medications are kept locked in the pantry in the kitchen. LPA observed the fire extinguisher is fully charged. Smoke detectors/carbon monoxide detectors tested operational. LPA observed both bathrooms are clean and operational. Hot water measured 112.8 to 116.0 degrees Fahrenheit. LPA observed all the resident rooms had the required furnishings. LPA observed a hole in the wall in resident room number 3. LPA observed missing tiles on the floor of resident room number 3. LPA toured the garage. The garage is kept locked and used for storage. LPA observed all exit gates in the backyard and front yard are operational. LPA reviewed 4 staff files. 2 out of 4 staff files reviewed had CPR training. 4 out of 4 staff files reviewed did not have the 20 hours of required annual training. LPA reviewed 4 resident files. 4 out of 4 resident files reviewed did not have a current reappraisal. LPA reviewed facility records. There is no documentation that the facility has conducted an emergency drill in the last 3 months. LPA observed and the Administrator verified the facility does not have an internet device for dedicated resident use. LPA consulted with the Administrator concerning reporting requirement and staff and resident document requirements. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report was provided along with appeal rights.