Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The facility is licensed for six non-ambulatory residents and has a hospice waiver for five. The facility is a two story home with three resident bedrooms, one of which is shared, one resident bathroom, a living room, a dining room, a kitchen, and an attached two car garage.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in resident bathroom. The hot water temperature measured at 119.6 Fahrenheit and all smoke detectors were operational. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed Resident 1 (R1) had half rails without a physician's order. LPA Mendivil was not able to review LIC 610E Emergency and Disaster Plan for Residential Care Facilities for the Elderly as there is no copy at the facility. LPA Mendivil did not observe documented emergency drills for the last two quarters.

LPA reviewed two out of two staff fingerprint records. LPA did not observe current staff training records. LPA Mendivil did not observe training materials. LPA conducted a complete review of resident record. LPA confirmed that administrator has a current administrator certificate which expires July 2, 2027.

Based on observations made during today's visit deficiencies are being cited per Title 22. A copy of this report, appeal rights were provided to facility representative.