Facility Evaluation Report

On 01/18/2024 at 9:03 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Chita C. Fortes & Geraldine Fajardo & Rolly Pabaira and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate and expires on 06/14/2025. The facility is licensed for four non-ambulatory clients and two ambulatory clients. Bedroom 1 is approved for bedridden. There are currently 4 clients who reside at this facility. This facility has approved hospice waiver for 1.

The LPA toured the facility with Geraldine Fajardo on 01/18/2023 at 10:00 AM.

During today's visit, the facility was sanitary and furnished. The facility has a public telephone and furnished common areas for clients in care. Client bedrooms and bathroom are furnished and sanitary. The laundry room is furnished and sanitary. The facility kitchen is sanitary and has an adequate food supply. The facility smoke detectors, carbon detectors, and fire extinguishers are in good repair. The facility first aid kit is complete and medication records are maintained. Medications are stored in a locked cabinet. The facility files are maintained. The exterior of the facility is clear of debris, and the exterior emergency exit doors are in good repair. The last fire drill was on 12/04/2023. The facility water temperature measured at 106 degrees and the facility temperature measured at 68 degrees.

Based on observation, interviews, and record review, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.