Facility Evaluation Report

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by staff after explaining the purpose of the visit. Administrator (AD) Imelda Aguila was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current with an expiration date of June 30, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for five. The facility is a one-story home with four resident bedrooms, one staff bedroom, two resident bathrooms, one staff bathroom, living room, dining room, kitchen, laundry room and an attached garage.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility and observed the following:

LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed six residents in care and four staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the facility entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed Resident (R1) has a half rail with no doctor's order; a deficiency was cited on today's date. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 114.8 and 116.7 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use.