Facility Evaluation Report

Licensing Program Analysts (LPAs) Jessica Cho, Edward Kim, and Faith La arrived at the facility unannounced for the purpose to conduct the Required 1 Year Annual Inspection. LPAs were greeted and granted entry by Caregiver Edgardo Sevilla and explained the purpose of the visit. Administrator (Admin) Baabak Sharifan was advised of the visit by telephone and arrived on premise approximately 1:00pm.

The facility is licensed for 6 and maintains a hospice waiver of 2. As of today, the resident census is 6 of which 2 are ambulatory, 3 are non-ambulatory, and no residents are receiving hospice care. At or approximately 9:34am, LPAs conducted a tour of the physical plant accompanied by the caregivers, and the following were observed:

This is a single-story facility comprised of five resident bedrooms and two resident bathrooms. Common areas include the kitchen, two dining areas, living room, laundry room, and a two-car garage. LPAs observed signs of personal belongings in the garage evidenced by (2) beds, clothing items, and personal hygiene supplies. The resident bedrooms had all the required elements with ample lighting. The residents' bathrooms were checked. Toilets and water faucets worked properly, and the grab bars were secure. Showers were free of mold/mildew, and the non-skid mats were in place. The hot water temperature measured within range at 105.2 and 106.3 degrees Fahrenheit. LPAs inspected the kitchen and the dining areas. Facility had adequate supply of two-day perishables and seven-day non-perishables but was lacking in quantity and variety of fruits to meet the two-day supply. LPAs observed during the visit groceries including fruits were dropped off at 2:33pm. LPAs observed 2 expired non-perishable food items in the pantry which were disposed during the visit. LPAs also observed the emergency food and water. Sharps were observed unsecured underneath the kitchen cabinet as well as the laundry detergent in the laundry room which were also corrected during the visit. The fire extinguishers were mounted, fully charged however was last serviced by the Fire Marshall on 12/30/2021.