Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 4/5/23 at 10:30AM to conduct a Required - 1 Year visit. LPA met with Caregivers Zenaida Tabhan and Carmen Hidalgo who are finger print cleared and associated to the facility. LPA explained the purpose of the visit. The facility is licensed to serve 4 residents of which 2 may be non-ambulatory in room 1 only.

Administrator certificate expires 6/5/23 for Zenaida Abriam.

LPA observed residents during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed kitchen, dining area, bedrooms and bathrooms, storage areas, laundry and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises.

The temperature inside the facility was observed to be at 73*F which is within the required range of 68-85*F. The hot water temperature was measured at 117.4 *F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Upon a file review the following items were discussed to be submitted with any changes annually:

Designation of Facility Responsibility (LIC308), Personnel Report (LIC500), Administrator Certificate-Updated

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited. Exit interview held, copy of report given