Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself. Facility administrator Heidi Baha was notified by telephone and arrived later to assist with the visit..

During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one-story home. Facility has one shared room and four private rooms plus one staff room, as well as one shared bathroom and half bathrooms in addition to the common living areas. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. The backyard has a shaded area and the routes of egress are free of clutter and obstructions. There are currently five residents admitted to the facility with two residents receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be above the required temperature. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted, however the current form is not in use. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguishers present are observed to be fully charged with up-to-date maintenance. Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed five resident files and four staff files.

Based on the observations made during today’s inspection, one type A deficiency and six type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Two Technical Violation and one Technical Assistance Advisory Note were provided to the licensee based on consultations provided during the visit. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.