Facility Evaluation Report

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/02/2023 at 1:00 PM. LPA Martinez met with Angelica Carbonel and Jeanette Del Rosairo and stated the purpose of today’s visit. LPA 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 expires on 06/20/2024. The facility is licensed for 2 non-ambulatory clients and 2 ambulatory clients. There are currently 4 residents who reside at this facility.

LPA Martinez toured the facility with Angelica Carbonell on 10/02/2023 at 2:00 PM.

The facility is sanitary and furnished. All common areas, client bedrooms, and client bathrooms are clean and furnished. The facility has an adequate food supply and has an emergency food and water kit. The water temperature measured at 105 degrees, and the facility temperature measured at 74 degrees. The facility smoke detectors, carbon detectors, and fire extinguisher were in good repair. The facility last fire drill was last week. The facility exterior emergency gate is in good repair. The exterior client patio is furnished and in good repair.

LPA Martinez reviewed four staff files and 4 employee files. The facility files were complete and maintained. LPA Martinez reviewed one client P&I file. The P&I file was maintained, and the facility has a surety bond. LPA Martinez reviewed one client medication administration record (MAR). The MAR was maintained. In addition, the facility has a first aid kit.

As a result of this annual visit, 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, and an exit interview was conducted. Moreover, a copy of this report was provided to the facility at the end of the visit.