Facility Evaluation Report

On 03/23/2023 at 9:30am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an Annual Visit. LPA Pascua met with Facility Designated Administrator, Remy Raqueno and explained the purpose of the visit. This facility is licensed to serve up to 6 residents of which 5 may be non-ambulatory. This facility is also vendorized by Valley Mountain Regional Center to serve and accept Level 3 residents at this time. The administrator holds an active and current administrator certification #6009143735 and expires on 12/26/2023.

Current census was 6. 6 out of 6 residents were out at their respective day program.

LPA reviewed 6 resident files. 6 out of 6 resident files are current and up to date. LPA reviewed 4 staff files. 4 out of 4 files are current and up to date.

A tour of the facility was conducted. A fire extinguisher was identified in the kitchen and was serviced by Butch Young Fire Equipment Inc on 03/06/2023.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Soap and cleaning supplies under the sink were locked. Additional non-perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. No soap or cleaning supplies were stored under the sinks. Hot water temperature was within the required range of 105-120 degrees. All Linen closets located in the hallways presented a sufficient amount of linen to supply for resident bedding.

A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.