Facility Evaluation Report

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 08/03/2023 at 2:20 PM. LPA met with Ma Grace Vista and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for 12 ambulatory residents. There are currently 12 residents who reside at this facility.

LPA Martinez toured the facility with Ma Grace on 08/03/2023 at 3:29 PM.

The facility was clean and in good repair. The facility temperature measured at 75 degrees. The facility’s hot water temperature measured at 105 degrees. The facility’s fire extinguishers are in good repair. The facility smoke detectors and alarm system are connected to the Fire Department. The last fire inspection was in March of 2023. The facility has a first aid kit, and the exterior emergency exit gate is in good repair. The facility has a public telephone. The resident bedrooms and bathrooms are in good repair. The facility has an adequate food supply, and all toxins are stored in a locked cabinet. LPA Martinez reviewed six resident files and two employee files. The files were maintained and complete. LPA Martinez reviewed two medication files, and the Medication Administration Records (MAR) were maintained.

Based on observation, interview, and record review, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time.

An exit interview was held, and a copy of this report was given at the end of the visit.