Senior Care Records.

Facility Evaluation Report

Jonathan Villa, Antelope08/08/2024Licence 345920076

Capacity4
Census4
Date signed08/08/2024 10:23:42 AM
The inspector’s account

On 08/08/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1- year annual inspection utilizing the care tool. LPA met with Administrator Romano Dumuk and Ivy Dumuk and explained the purpose of the visit.

Administrator and LPA conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to four (4) resident bedrooms, two (2) bathroom, kitchen, garage, common areas and backyard.

LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins and cleaning supplies are locked and inaccessible to residents in care. The temperature in the facility was 72 degrees. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located near the kitchen, which was last inspected on 07/22/24. LPA reviewed drill logs, which are conducted monthly. LPA observed required Licensing posters posted throughout the facility.

LPA reviewed four (4) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for two (2) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). LPA reviewed a total of three (3) staff record. Staff has training in infection control, first aid and CPR, and other various areas of care provision.

No deficiencies are being cited during today's inspection.

Exit interview conducted and copy of the report was left at the facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction