Facility Evaluation Report

Licensing Program Analyst (LPA)Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Flor De Guzman and explained the reason for the visit. Administrator Vijay Kanase arrived at 1:45pm.

At 1:03PM, LPA toured the facility with Caregiver Flor De Guzman. Facility is 4 bedroom, 1 staff/storage room, 3 bathroom, single story home with an attached garage. Facility has 3 residents present during today's visit. LPA observed residents relaxing in the facility and in their respective rooms. Facility appears clean and sanitary. All residents rooms had the required elements as well as restrooms stocked with soap/ sanitizer. LPA observed ring cameras in 2 out of 4 resident bedrooms. LPA observed postural supports in 2 out of 4 resident bedrooms. Administrator was unable to provide physician's orders for postural support. LPA observed the screening/ sanitizing station in the entrance of the facility. The facility mitigation plan has been completed and approved. LPA observed emergency food and water. LPA observed unsecured pre-poured prescription medication in kitchen cabinet. LPA observed locked medication cabinet .LPA observed unsecured cleaning supplies under sink. LPA toured the outside grounds and observed outside shaded visitation area. LPA observed 2 out of 2 exit gates were locked. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPA observed PPE supply. LPA reviewed all residents files and all contained required documentation including updated emergency information. All staff and residents are vaccinated for Covid 19.

Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights