Facility Evaluation Report

On 9/23/2025, Licensing Program Analysts, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct an annual continuation visit to continue the annual visit initiated on 9/11/2025. LPA initially met with the staff on duty (S3) and explained the purpose of today’s visit. The facility manager, Bulou Matamadua (S2), was informed of the visit and arrived at 9:55am. Present during this visit were 4 residents in care with 2 staff on duty (S2 and S3).

During this visit, LPA conducted record reviews.

Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to ensure resident files are complete and current.

Medication review of 2 residents (R1, R3) include review of physician orders for over-the-counter medications and PRN records. Advisory was provided to ensure each residents have on their files: PRN authorization letter and current prescription orders.

Review of 5 staff files (S1 - S5) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Advisory was provided to ensure each staff have complete records on file and omit documents unrelated to this facility.

LPA also reviewed fire drill/disaster drill records; facility conducts at least quarterly drills.

LPA requested a copy of current facility's Liability Insurance Certificate, LIC500 and LIC308 during this visit. DEFICIENCIES from last visit have been corrected.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited. Exit interview was conducted with S1. A copy of the report was provided upon exit.