Facility Evaluation Report

Licensing Program Analyst’s (LPA’s) Alyssa Ramirez and Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA’s was welcomed by, identified themselves to, and discussed the purpose of the visit with Manager Thomas Gilbert. Administrator Ligaya Sanders later arrived to meet with LPA’s. According to the facility’s license, the facility is licensed for six (6) residents. Facilities current census is five (5).

LPA’s, accompanied by staff, toured the interior and exterior of the facility, and inspected resident bedrooms. Resident bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. Hot water temperature was in compliance.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on premises.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher and first aid kit present. Required licensing postings were observed in visible areas of the facility.

LPA’s interviewed staff/residents and reviewed multiple staff/resident files. The files which LPA’s reviewed did not contain all required documents.

Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). Plans of Corrections were jointly developed with the Administrator. An exit interview was conducted with Administrator, to whom a copy of this report, the LIC 809-D and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.