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, Adetayo Kokumo joined 30 minutes later. LPA explained the purpose of the visit to Administrator and staff. Administrator certificate # 7036073735 expired on 06/24/2023. Administrator provide proof of cashiers check and training certificates for 40 hours that was submitted to CCL on 06/22/26. Application is shown as received on ACB Pending Renewal Applications List.

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. Facility is a 6 bed facility with a current census of 5. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The medications noted to be locked to residents in care. LPA also conducted the care tool. No bodies of water were observed at the facility.

Hot water temperature was measured at 118 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. 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.

LPA observed the facility to have adequate food supply of 7 days non-perishables and the facility did not have 2 days perishables in place. Resident rooms were not sanitary and had the required furniture and furnishings.