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 Maria Jasmin Avila and explained the reason for the visit. Maria Jasmin Avila's Administrator's certificate expires on June 11, 2026. The facility is licensed for 6 non-ambulatory residents of which 1 can be bedridden and a hospice waiver for 6. The facility is a one story house with an attached 2 car garage with 5 bedrooms, 2 bathrooms, dining room, kitchen and living room with a screened fireplace. LPA observed the fireplace is gas operated and the key is kept locked in the kitchen. LPA observed the See Something, Say Something poster (PUB 475) posted next to the front door. LPA observed all rooms have the required furnishings. LPA observed both bathrooms are clean and operational. Hot water measured 113.5 degrees Fahrenheit. LPA observed clean linens stored in the hall closet. 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. Knives and sharp objects are kept locked in a kitchen cabinet. Medication is kept locked in a cabinet. LPA observed the 5 burner cook-top stove lights unassisted. The fire extinguisher in hallway next to the kitchen is fully charged. The garage is kept locked and used for storage. LPA observed extra food and supplies stored in the garage. Smoke detectors/carbon monoxide detectors tested operational. There is no documentation for a current emergency disaster drill. Facility has a dedicated internet device for resident use. Facility has a courtyard in the front of the facility. There is a shaded seating area in the front courtyard. LPA and Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs in the backyard. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 4 resident files and medications, no discrepancies observed. LPA reviewed 4 staff files. LPA observed there is no documented t annual raining for 3 out of 4 staff members. No other discrepancies observed. All 4 staff members have current CPR training. 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.