Facility Evaluation Report

On 7/20/2023, at 10:25 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver, Arvin Valenciano who was informed of the purpose of visit. At the time of visit there was five (5) residents, and two (2) staff present.

The facility is approved to care for six (6) non-ambulatory residents and has a dementia program along with a hospice waiver for two (2). Facility has a bedridden fire clearance for six (6) residents. LPA toured the facility inside and out with Caregiver Valenciano. During the visit, LPA observed the following:

Kitchen: LPA observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. LPA observed food supply met the requirement for a two-day supply of perishable food and seven-day supply of non-perishable food. Sharps are secured in a locked kitchen drawer.

Dining and Livingroom: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition.

Hallway : LPA toured the hallway and observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detector were tested and functioning properly. Fire extinguisher is charged and up to date.

Records: Staff present possess criminal background clearance and association to the facility. Administrator’s certificate expires on 10/18/2023.