Facility Evaluation Report

Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the caregiver Liz Baclagan at the front door and was granted entry.The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for five (5) ambulatory and residents of which one (1) non-ambulatory. The Facility has a hospice wavier with total care for two (2).

Physical Plant: front entrance, interior and surrounding exterior were clean and in good repair with no pathway obstruction; doorway alarms were in working order; residents' main restroom water temperature read at 114.3 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all of the residents' bedrooms; fire alarm were in working order. Facility does not house firearms and/or ammunition on grounds.

Food Services: 7-day non-perishable and 2 day of perishable food supply was observed and all food was properly stored and available to residents.

Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption. Staff responsible for direct care and supervision have current First Aid / CPR training. Licensee has completed a written admission agreement, current medical assessment and needs and service plan with each resident. Exceptions & waivers are in place and meet said terms. Licensee handles no resident cash resources.