Facility Evaluation Report

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Himat Singh and explained the purpose of the visit.

LPA Moleski reviewed five resident files (R1-R5) and three staff files (S1-S3). First aid/CPR certifications for S1-S3 were expired as of 10/21/24. S3 had a tuberculosis test completed as of 4/21/22, but did not have a completed health screening on file. S3's health screening was unsigned and undated, and did not contain an evaluation of general health, or other pertinent comments from an attending medical professional. All five residents' centrally stored medication records did not include start dates for any medications received this year. One resident had no start dates recorded since 2022 (R5). Per Singh, this facility does not maintain daily medication administration records, meaning that without start dates, there is no way to verify correct dosages have been provided to residents.

LPA Moleski toured the facility with Singh and inspected common areas, the kitchen, bedrooms, bathrooms, and outdoor areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 66 degrees Fahrenheit, which is not within the required range of 68 and 85 degrees. The facility's water temperature measured 105 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski interviewed one staff member (S2) and two residents (R2, R6). This facility is hereby cited per 22 CCR Sections 80066(a)(10), 80075(f), and 85075(b). An exit interview was held with Singh. Appeal rights and a copy of this report were left with Singh.