Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Melissa Sanchez, to conduct a case management health and safety check. LPA spoke with Administrator, Juan Ramirez, via telephone call, who gave permission to have caregiver sign report.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA checked two (2) residents' medications and observed medication to be locked and inaccessible to the residents in care. LPA reviewed four (4) resident records. LPA observed staff on the premises to have a criminal background clearance on file.

As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8 due to LPA observing medication errors for 1 of 2 residents. A civil penalty in the amount of $250 was assessed for a repeat violation as a result of today's visit. Deficiency is listed on 809-D page.

Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.