Facility Evaluation Report

Licensing Program Analysts (LPA) Melina Oropeza arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined 20 minutes later. LPA explained the purpose of the visit to Administrator, Jessica Dizon and staff. Administrator certificate #7008894735 expires 03/30/2028.

Facility is a 6 bed facility with a current census of 6. The facility was vendorized to be able to accept and retain up to (6) Level 6 residents at any given time. This facility is licensed to serve up to (6) Ambulatory residents at any given time.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. There is entry door is leading to the living room and kitchen. LPA inspected the upstairs of the facility which included bedrooms, bathrooms and laundry room. Resident rooms were sanitary and had the required furniture and furnishings.Chemicals noted to be locked in the laundry room and made inaccessible to residents in care. Medication cabinet was observed to be locked and made inaccessible to the residents. A review of the facility Medication Administration Record and dispensing log was conducted. LPA also conducted the care domain tool.

Hot water temperature was measured at 108 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils.