Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Administrator (AD) Adelina Moncera and the purpose of the inspection was discussed.

During the inspection LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a two-story home with two resident bedrooms, one staff bedroom, two bathrooms, and attached two-car garage on the first floor. The second story is used solely as staff quarters. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. The one and only facility resident was observed watching television in the living room. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 116.7 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, and laundry washer and dryer were all observed to be operable. Sharps, all and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA conducted record review of one of one resident file and one staff file. LPA interviewed AD and resident.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.