Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio and Jamie Ivey Canady arrived unannounced to conduct a required - 1 year visit. LPAs were met by Administrator Emerito Gaspar. Administrator Certificate 6024933735 with Exp. 02/19/2023 was observed to be on file.

LPA conducted the infection control domain tool. LPAs observed the facility to have a first aid kit. Hand washing signs and COVID - 19 informational signs posted at the front door and throughout the facility. Common touch surfaces are cleaned after each use. Facility has a 30-day supply of PPE.

The physical plant was toured inside and outside to ensure compliance with Title 22 regulations. Resident bedrooms were observed to have necessary furniture and furnishings. LPAs observed the temperature inside the facility was measured at 69*F. The hot water was measured at 107*F, which is not less than 105 degrees F and not more than 120 degrees F as per Title 22 regulations. Facility has food supplies: nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. The centrally stored medications area to be locked and inaccessible to clients. LPAs observed a pull alarm system, fire extinguisher(s) with last check on 11/24/21, smoke and carbon monoxide detectors, central heating and air in the facility.

During the visit, 2 staff files and 2 resident files were reviewed. Files were up to date with current information.

LPAs requested the following documentation to be sent via fax to LPA Jamie Ivey Canady: LIC 500, LIC 610D, LIC 308, Administrator Certificate

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Exit interview held, and copy of report given to Administrator Emerito Gaspar.