Facility Evaluation Report
On 08/10/2024 at 11:45 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. Licensee/Administrator Israel Cabreros was contacted and informed of the visit. Administrator Applicant Ishmael Siapco arrived during the visit. LPA Brown explained the purpose of the visit to Administrator Applicant Siapco.
The facility is a seven (7) bedroom, four (4) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which five (5) can be Non-ambulatory and one (1) bedridden. The facility has six (6) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following:
Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor but obstruction to outdoor passageways was observed as evidenced of old mattress, wooden desk in disrepair and old electric fans in the outdoor passageways during the visit. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. However, LPA Brown observed one (1) resident bathroom sink, in disrepair. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 102 degrees Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. ***Continuation in LIC809C ***
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction