Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Facility is a licensed RCFE with a capacity of 6 non-ambulatory residents with a hospice waiver for 4. The facility is a single story 5 bedroom (1 bedroom is for staff) house with 2 bathrooms, living room, dining room, family room, kitchen and a 2 car garage. LPA observed the See Something, Say Something sign (PUB 475) posted next to the front door. The fireplace in the living room is screened. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the 4 burner gas cook top lights unassisted. LPA observed knives and medications are kept locked in a kitchen cabinet. LPA observed all resident rooms had the required furnishings. Smoke detectors/carbon monoxide detectors tested operational. LPA observed in bathroom 1 in the hallway, the window glass is broken and the window is taped. LPA observed in bathroom 1 the vanity lights did not work. The hot water measured 111.0 degrees Fahrenheit in bathroom 1. LPA observed two holes in the hallway wall that are taped up with plastic. Staff could not explain the nature of the repair being conducted with the hallway wall. LPA observed clean linens in the hallway closet. The garage is kept locked and used for storage. The garage has emergency food and water and cleaning supplies. LPA toured the backyard. No bodies of water observed. Both exit gates are operational. There is a shaded seating area for residents to sit outside. The last fire drill was conducted on October 14, 2024. LPA reviewed 5 resident records and medications. LPA observed 1 out 5 residents did not have a current appraisal (Resident 3), no other discrepancies noted . LPA reviewed 2 staff files. Both staff members are background cleared and associated to the facility. Both staff members have current CPR/First Aid training. Staff 2 has an Administrator's certificate and documented proof of training. Staff 1 has no documented training. Staff verified the facility has internet service but no dedicated internet device for resident use. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.