Facility Evaluation Report

Unannounced annual visit made out to this facility on 10/25/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Theresa Katz, who was briefly interviewed. This LPA requested that she go ahead and contact the facility designated Administrator to let her know that CCL was present at this time for an annual visit.

It was learned that the facility designated Administrator Ada Osuka was unavailable at this time and would not be able to be present for today's annual visit.

Current census was 5 residents and they were all present at the time of this visit.

This facility was vendorized through Valley Mountain Regional Center to accept and retain Level 4I residents at any given time.

Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed.

Medication cabinet was observed to be present and properly locked to make it inaccessible to the residents at all times. Policies and procedures were discussed with the facility caregiver in terms of dispensing, documenting, and overall administration of resident medications.

First aid kits were observed to be present and contained all of the necessary components at this time.

Policies and procedures were discussed in relation to the documentation of the medications that required initials by incoming staff and outgoing staff. A review was conducted in regards to this documentation of the resident medication administration record and dispensing log.

A tour of the facility resident rooms was conducted. Resident furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

Resident restrooms were toured and observed to be able to meet the needs of the residents at this time.

Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at this time.

Living area, dining area, and all other areas intended for resident use were toured and observed to be in compliance at this time.

Fire extinguishers (2), located in the kitchen area and facility hallway, were observed to have been