Facility Evaluation Report
On 01/10/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Cassie Yang arrived unannounced at the facility to conduct a Required 1- year annual inspection utilizing the care tool. LPAs met with caregiver Leriza Arambulo and explained the purpose of the visit.
LPAs and Caregiver conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: four residents room, two bathrooms, kitchen, storage area, and the common areas. LPA observed the facility to have 2+ days of perishable and 7+ days of nonperishable foods.
LPAs observed seven bottles of PRN medication present in R1s room.
LPAs conducted a file review of personnel and residents records. LPAs observed two personnel files to be incomplete with no annual training. One personnel file to be missing first aid training. LPAs observed resident records to be missing LIC501 and updated LIC602. LPAs additionally provided facility with LIC311f which states required documents for personnel and resident files.
LPAs completed the full care tool and deficiencies was observed. Please see LIC 809-D.
Exit interview conducted and a copy of the report and appeal rights was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction