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 explaining the purpose of the visit. Facility administrator Josephine Teehankee was notified by telephone and arrived shortly afterwards to assist.

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 with six private bedrooms and one staff room in addition to the facility's common living areas and two full bathrooms, including one en-suite. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. One resident awaiting hospice admission is observed to have a bed equipped with full rails. LPA provided a consultation on hospice requirements for full bed rails and observed staff replacing the postural supports with half rails during the visit. 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 one resident receiving hospice care and another one pending admission. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Fire drills are conducted quarterly. 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 extinguisher 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, two hospice files and four staff files.

Based on the observations made during today’s inspection, one type B deficiency are being cited per Title 22 Division 6 of the California Code of Regulations along with one advisory note provided. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.