Facility Evaluation Report

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Diana Gunita after explaining the purpose of the visit. Administrator (AD) Ali Naghibi was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current with an expiration date of June 9, 2028. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for six. The facility is a one-story home with six resident bedrooms, one staff bedroom, seven bathrooms, living room, dining room and an attached two car garage.

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 watching television in their respective bedrooms. LPA observed five residents in care and three staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the living room. LPAs observed that 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, toilet paper, paper towels, and non skid floor mats. Bathrooms faucets and toilets were operational. Water temperature tested between 108.1 and 111.2 degrees Fahrenheit. LPA observed all windows were appropriately screened. 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.