Facility Evaluation Report

On 7/24/24, at 10:09am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct their quarterly case management visit due to a current stipulation order in place. The facility is licensed under a probationary license. LPA met with the facility administrator, Annie Lyn Rodriguez and stated the purpose of the visit. Present in today's visit were 3 residents in care with 1 staff on duty.

At 2pm, LPA conducted a physical inspection of the facility. Facility is located in a residential neighborhood and is approved for 6 non-ambulatory elderly residents, fire cleared for 1 bedridden resident, and approved for 3 hospice resident. LPA observed front and back yard to be maintained and free of obstruction. Fences and gates were observed to be in good repair. Bedrooms and bathroom were observed to be clean and in good repair. Kitchen was observed to be clean and sanitary. Medications, sharp objects and toxins were observed to be locked and inaccessible to residents in care. Refrigerator and freezer temperature were measured within regulatory standard. Room temperature was measured at 74*F. Hot water temperature was measured at 110*F during this visit.

LPA conducted review of 3 staff records and 3 resident records. 3 of 3 staff records have current 1st aid/CPR certificates. 1 of 3 staff reviewed was a newly hired and have current health screen and fingerprint cleared. Discussion and advisory with the administrator was conducted to update 3 of 3 residents' Needs and Services Plan. Medication review was conducted for 2 of 3 residents and were observed to be in compliance.