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 Arlyne Cornejo and explained the purpose of the inspection.

During the inspection, LPA and Staff Cornejo 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 home with six resident bedrooms, one staff bedroom, three 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 watching television 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. Water temperature tested between 138.3 – 152.6 degrees Fahrenheit; a Deficiency was cited on today’s date.

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. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication cabinet was observed to be locked; however, medication is being pre-poured into a plastic weekly medication organizer for each resident; a Deficiency was cited on this date. Upon review of Resident 1's (R1's) medication records, there was no authorization from their physician for one of their prescribed medications and staff was unable to provide LPA with a copy of authorization; a Deficiency was cited on today's date. Medication requiring refrigeration was also observed to be to accessible to all facility residents in the kitchen fridge; a Deficiency was cited on today's date. (Cont. LIC809-C)