Facility Evaluation Report

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Michael Oliva and explained the purpose of the visit.

LPA Moleski reviewed four resident files (R1-R4) and four staff files (S1-S4). R2's LIC 602, dated 3/29/22, indicates that R2 is nonambulatory. The LIC 602 indicates that R2 is considered nonambulatory based on R2's mental condition. Oliva said R2 did not have a more recent LIC 602. This facility is approved to accept only ambulatory residents, per the facility license.

LPA Moleski toured the facility with Oliva and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 74 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 105 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked closet for the storage of medication. LPA Moleski observed locked storage areas for the storage of cleaning solutions and knives.

LPA Moleski interviewed one staff member (S2) and one resident (R4).

This facility is being cited per 22 CCR Section 80010(b) . An exit interview was conducted and a copy of this report was left with Oliva.