Facility Evaluation Report

Licensing Program Analysts (LPAs) Joseph Alejandre and Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPAs met with Licensee Janeth Figueroa and explained the reason for the visit. Facility is a one story home with 5 bedrooms, 3 bathrooms, living room, dining room, kitchen and an attached two car garage. Facility is licensed for 6 non-ambulatory residents and a hospice waiver for 4. LPA observed the see something, say something poster (PUB 475) is 8 1/2 by 11 inches. LPA observed the fireplace in the living room and the fireplace in the dining room are not screened. Licensee reported that the fireplaces are not in use. LPAs and the Licensee toured the facility. LPAs observed all resident rooms had the required furnishings and bed linens. All 3 bathrooms are clean and operational, grab bars are secure and non-slip mats in place. Hot water measured 108.0 to 109.8 degrees Fahrenheit. LPAs observed a clean supply of linens and towels in the hall closets. Smoke detectors/carbon monoxide detectors tested operational. The fire extinguisher in the living room and dining room are fully charged. LPAs observed the kitchen is clean and organized. The medication is kept locked in the closet. The kitchen stove lights unassisted. LPAs observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPAs observed the lock on the drawer for the knives and sharp objects is inoperable. The garage is used for storage and kept locked. LPAs and the Licensee toured the backyard. No bodies of water observed. There is a table with an umbrella and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPAs reviewed facility documents. There is no record of any emergency drills being conducted in 2024. LPAs reviewed 6 resident files and medications. LPAs observed the residents' medication is pre-poured and stored in plastic containers for tomorrow. LPAs observed Resident 3 (R3) does not have a current physician's report (LIC 602a). LPAs reviewed 3 staff files. 3 out of 3 staff files did not have verification for 20 hours of current annual training. All 3 staff have current CPR training. LPAs inspected the first aid kit. The first aid kit has all the required elements. LPA consulted with the Licensee regarding reporting requirements and safety requirements for RCFEs. 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 provided along with appeal rights.