Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Azalia Ayala and explained the reason for the visit. Administrator (Admin) Lourdes Rivero arrived on premise to assist with the inspection. Administrator Rivero has a valid administrator's certificate expiring on July 30, 2026.

The facility is a single story structure and is licensed to operate for six non-ambulatory residents and has a hospice waiver for two residents. Based on observation, there are two staff on duty caring for six residents of which three are in hospice care. It is determined that facility is operating beyond the conditions and limitations specified on the license by exceeding the number of hospice residents that can be accepted at one time. During the walk through, LPA observed four resident bedrooms and two and a half resident bathrooms. Resident bedrooms had all required furnishings. LPA observed the following issues in the bedrooms: Resident #5 (R5) did not have a bed rail order and the window screen in the bedroom of Resident #4 (R4) has a tear that needs to be repaired. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 109.4, 107.0, and 107.7 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA observed sufficient emergency food and water in the garage. LPA did not observe a generator and/or emergency lights as indicated on the Emergency Disaster Plan (LIC 610D). Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. Both exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was charged, mounted, and serviced on April 22, 2024. The auditory devices dual functioning smoke/carbon monoxide detectors were tested and operational. The auditory device in the master bedroom sliding door was not operable.