Facility Evaluation Report

On this day, Licensing Program Analysts (LPAs) Andrea Mendivil and Nancy Guillen made an unannounced visit to conduct a required annual. LPAs was greeted and granted entry by staff and explained the reason for the visit.

The facility is licensed for six non-ambulatory residents of which one may be bedridden. The facility is a single story home with four resident bedrooms, one staff bedroom, five shared resident bathrooms, living room, a dining room, a kitchen, a den, a computer room, and an attached two car garage.

During today’s visit, LPAs toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in resident bathrooms. The hot water temperature measured between 120 and 128.8 degrees Fahrenheit. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs observed unsecured medications in Resident 2's bathroom. LPAs observed an unsecured kitchen knife in the couch cushion of the facility den.

LPAs conducted a complete review of five out of five resident records. LPAs were not able to view staff records. LPAs confirmed that administrator has a current certificate which expires on November 25, 2026.

Based on observations made during today's visit the following 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 was provided.