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 Staff Elma Ilagan. Licensee Ervin Bumanglag arrived at approximately 1:30 p.m. and the purpose of the inspection was discussed.

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

This is a one-story house with four resident bedrooms, one staff room, two bathrooms, and attached two car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents engaging in bingo in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. 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, washer, and dryer were all inspected and observed to be operable. Medication was observed to be centrally stored and locked. LPA reviewed four resident files and three staff files. Three of three staff files did not contain a health screening which includes a chest x-ray or an intradermal test, performed by a physician; a Deficiency was cited on today's date. LPA interviewed residents and staff.

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