Facility Evaluation Report
On 11/20/2024 at 09:08 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. Licensee/Administrator Maria Araceli Undan was contacted and informed of the visit. Licensee/Administrator Undan arrived at the facility during the visit. At the time of the visit there were two (2) staff present, and six (6) residents present.
The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room and laundry room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility’s approved for two (2) hospice waiver. The current census is six (6) 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). There are no obstructions to indoor passageways. However, LPA Brown observed outdoor passageways not free of obstruction. Deficiency will be issued. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with mattresses, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient lighting throughout the facility. However, LPA Brown observed missing one (1) night stand on Room #3 and missing chairs on all resident rooms. Technical Violation will be issued. LPA Brown measured and observed the water temperature in the bathroom to be at 98.9 degrees Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, and the disaster plan were posted in a common area. During the tour of the facility, LPA Brown observed one (1) window screen in disrepair. Technical Violation will be issued. ***Continuation in LIC809C ***
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction