Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and Samer Haddadin conducted an unannounced visit to conduct the annual required visit. LPAs were greeted and granted entry into the facility by Caregiver Irene Zamora and explained the reason for the visit. Facility is licensed for 3 ambulatory and 3 non-ambulatory clients of which 3 may be bedridden. Bertha Lopez has an Administrator Certificate expiring on 05/29/2025. The facility appears clean and sanitary.

LPAs Lyman and Haddadin along with Caregiver Irene Zamora toured the facility at 8:16 AM. LPAs toured the physical plant, checked food service, and reviewed facility documentation. The home consists of four client bedrooms, one shared hall bathroom, client restroom, one staff room, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 113.7 and 118.5 degrees F in facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers is fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and there is ample shaded seating for clients. Exit gate is unlocked, self latching and operational. LPAs observed ample emergency food and water supply. LPAs reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 06/10/2024 and drills are conducted quarterly. Facility provides activities in the form of games, painting and outings in the community. At 9:00 AM, LPAs reviewed four client files and three staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files reviewed contained required documentation of training and all pertinent paperwork. CONTINUED ON LIC 809C DATED 08/06/2024.