Facility Evaluation Report
On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by Caregiver Esther Forsyth and explained the nature of the visit. Upon arrival to the facility, LPA Called and spoke to Licensee/Administrator Louie Dormido via telephone and explained nature of the visit. Administrator (AD) Kenneth Forsyth arrived to facility shortly after and met with LPA Quiroz.
This facility is licensed to provide services to residents age range 60 years and over, 6 Non-Ambulatory Residents and has a hospice waiver for two (2) residents. AD Kenneth Forsyth has an Administrator Certificate with expiration date of 02/15/2023.
On or about 1:22pm LPA Quiroz along with AD Kenneth Forsyth toured the inside and outside of facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed one (1) resident in living-room area resting watching television. Three residents were observed in their bedrooms resting. AD Forsyth indicated R1 is currently not at the facility and is at a Skilled Nursing Facility. Four of five residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. AD Forsyth indicated facility is taking temperatures daily; however not documenting results.
LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction