Facility Evaluation Report

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Karim Morales and was granted entry to the facility. The facility is a (5) bedroom, (3), bathroom home and, with a kitchen/dining area, living room and attach garage. Licensed capacity is (6) current census (2). LPAs were accompanied by caregiver Karim Morales 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 (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. The facility is equipped with operating carbon monoxide alarms and fire alarms. Posters such as personal rights, the CCL complaint poster, in the common area. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly.

Deficiencies that were found during facility tour: LPAs inspected residents’ bedrooms; R1 and R2 had mattresses, nightstands, storage space, but did not have chairs. During facility tour, LPAs observed two electric wires hanging off of the wall by residents’ bedrooms, this is fire hazard for residents in care. R1 and R2 did not have non-skid mats inside their bathroom tub. LPAs tested residents’ water; the temperature tested at 126 F. No cautions warning signs posted. In addition, during facility tour, LPAs observed the facility kitchen hallway, living area, resident’s hallways and (2) resident’s bedrooms did not have light installed nor lamps for appropriate lighting. LPAs inspected kitchen cabinets, (8) kitchen cabinets were dirty, with food crumbs and dirt. Furthermore, LPAs observed the window located by the dining area did not have a window screen install. LPAs and S1 tested facility phone, the phone was out of service. During facility tour, R1 and R2 bathroom was not free from incontinence odor. Next, LPAs tested exit monitor device for residents with dementia. The devices were turned off. The facility currently has (1) dementia residents, facility must always remain devices on.