Facility Evaluation Report
On 04/29/2024 at 11:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there was two (2) staff present, and five (5) residents present. House Manager Leofel Capulong and Administrator Paul Krause were contacted and arrived during the visit. LPA Brown explained the purpose of the visit to House Manager Leofel Capulong and Administrator Krause.
The facility is a five (5) bedroom, three (3) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents of which one (1) may be bedridden. The facility has two (2) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #3 (S3) to conduct a general overall inspection, which included, but was not limited to, the following:
Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars but no non-skid mat in the resident shared bathroom. Deficiency will be issued.
Also, LPA Brown observed Resident #2 (R2) with half bed rails and House Manager Leofel Capulong reported to LPA Brown that R2 does not have a written order from R2's Physician indicating the need of half bed rail for mobility. Deficiency will be issued. ***Continuation in LIC809C ***
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction