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 by staff and explained the reason for the visit.

Facility is a single story house with 5 bedrooms, 2.5 bathrooms, and a three car attached garage. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are six residents of which two are on hospice during today's visit.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in the bathrooms. The hot water temperature measured 109 and 114.9 degrees 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 secured medication storage. LPA observed emergency food and water in facility garage.

LPA was not able to review staff training or residents documents due Licensee stated all documents are off site. LPA observed emergency and disaster drill documents.

Based on the observations made during today's visit deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeals rights were provided.