Facility Evaluation Report

On 09/13/2021 at 11:10 AM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA called to ensure that the facility does not have any positive COVID-19 cases. LPA met with Assistant Administrator Sharon Perez and explained the purpose of the visit.

Administrator Suzanne Perez holds current certification #6018430740 and expires on 7/14/2022. The facility is licensed to serve up to (6) six non-ambulatory residents. Approved hospice waiver for (4) four residents. There are currently (3) three residents who reside at this facility. LPA toured the facility with Assistant Administrator Sharon Perez on 09/13/2021 at 11:20 AM.

LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 118.2 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to residents. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool.