Facility Evaluation Report, 05/08/2023 — Mother Mary Care Home, French Camp CA

On 5/8/23 at approximately 1:20pm Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to conduct a required 1 year annual inspection. LPAs Jensen and Fain met with care provider Jose Alvarez and explained the purpose of today's visit. The Licensee/Administrator Jean Alvarez is away and an LIC 308 assigning responsibility to Jose Alvarez in the Administrator's absence was received by the Department. The Administrator holds current Administrator's certificate # 6061970740.

LPAs Jensen and Fain toured the physical plant and grounds. The grounds were observed to be maintained and outdoor furniture in a shaded area is available for resident use. The facility currently has 3 residents in care. LPAs Jensen and Fain inspected the bedrooms, bathrooms, kitchen, staff quarters and common areas. The thermostat was set at 72 degrees for the comfort of residents in care. Knives, toxins, cleaning supplies were observed to be locked and inaccessible to residents in care. There are currently 2 bedrooms in use, both rooms are double occupancy. 2 of 2 residents bedrooms did not have lamps available. The bathrooms were equipped with grab bars in the shower and at the toilet. The water temperature in the main bathroom adjacent to the common area was measured at 115 degrees which falls within the required regulatory range of 105-120 degrees Fahrenheit. The facility maintains a 2 day supply of perishable food and a 7 day supply of non-perishable food. There is also an adequate supply of linens. The fire extinguisher was last serviced in April of 2023 and is in compliance. The carbon monoxide detector was tested and found to be in working order. The first aid kit was observed to be complete with scissors, tweezers, thermometer, various wound dressings and manual.

LPA Jensen reviewed 3 of 3 resident files and 2 of 2 staff files. 1 of 3 resident files were missing safeguards for personal property. 2 of 2 staff files were determined to be complete and in compliance. LPA Jensen interviewed 2 of 3 residents in care.