Facility Evaluation Report

On October 09, 2024, Licensing Program Analyst (LPA), Venus Mixson, made an unannounced visit to the facility for the purpose of conducting the Required Annual inspection, and met with Administrator, Aleli Bombongan, introduced herself and stated the purpose for the visit. The facility file review was conducted in the RO and additional records were requested and reviewed on site.

Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures.

PHYSICAL PLANT : Facility is licensed for six Elderly Adults and is operating at four Elderly Adults which is within the conditions and limitations of the license. Outdoor and indoor passageways are kept free of obstruction and clutter. No pool or body of water were observed on the property. According to staff, there are no known weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to residents in care.

Temperature -was within in regulations for this time of day and the season. There was sufficient lighting throughout the facility and the Hot water tested within regulations at 105. degrees F and was logged. Fire extinguisher located in dining area, and next to the kitchen area has proper inspection tag. The smoke and carbon monoxide alarms were in the green and last inspected on 09/23/2024, By Redline Fire Protection Services in Colton. The interior and exterior areas of the home were observed to be clean and organized.

FOOD SERVICE : Menus were posted and available for review. There was a variety of food types and were sealed and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean, neat, and organized. LPA observed the required two-day supply of perishable and seven-day supply of non-perishable food items.