Facility Evaluation Report

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to conduct a required annual comprehensive inspection of the facility. LPA Martinez met with, explained the purpose of the visit to, and was granted entry into the facility by Director/Administrator Aurea Arquisola. Two (2) staff and (2) residents were present at time of visit.

Facility is operating in the capacity approved by Community Care Licensing Division (CCLD); licensed for capacity of three (3) residents-- fire clearance for one (1) ambulatory and two (2) non-ambulatory, (1) of which can be bedridden in Room #1. Facility has hospice waiver for (3). LPA was accompanied by Director/ Administrator Arquisola to conduct a general inspection, which included, but was not limited to the following:

Physical Plant : The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry area and attached two (2) car garage. LPA observed bedrooms designated for resident’s use are rooms #1 and #2; Bedrooms #3, #4, and #5 are being used by Licensee and family; all adults residing in home have appropriate criminal background clearances and associations to facility. LPA observed no obstructions to indoor passageways. Obstructions to outdoor passageway observed on left side of house. Technical Violation (TV) deficiency to be issued. The facility indoor temperature was maintained at a comfortable 75 degrees Fahrenheit. LPA inspected resident bedrooms to be equipped with sufficient lighting as well as required furniture (e.g., mattresses, nightstands and storage space). LPA observed bathrooms were clean and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. Hot water temperatures measured at 107.2, 112.1, and 106.4 degrees Fahrenheit. The facility maintains an adequate supply of extra linens and towels.