Facility Evaluation Report

On 04/27/2023 at 9:20am, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to the facility to conduct an Annual Visit. LPA Pascua was greeted by staff member, Jazmin Virrueta and explained the purpose of the visit. It was asked by the LPA to call the Facility Designated Administrator to inform them that CCL was present at the facility at this time. It was learned at this time that the Facility Designated Administrator was unable to come to the facility at this time. LPA was directed that she may continue her visit with Facility Designated Representative (FDR), Toribio (TJ) Castro.

Current census is 6. 1 out of 6 residents were out at their respective day program at this time. This facility is licensed to serve up to 6 ambulatory residents. This facility is also vendorized by Valley Mountain Regional Center to accept and serve 4I residents at this time.

At 9:30am, LPA reviewed 6 resident files. 6 out of 6 resident files were complete and up to date. LPA reviewed 4 staff files. 4 out of 4 staff files were complete and up to date. The Facility Designated Administrator, Jessica Dizon has an active administrator certificate #6029775735 and expires on 03/30/2024.

At 10:30am, LPA initiated a tour with FDR Castro.

LPA observed a locked centralized stored medication cabinet located in the hallway. Along with FDR Castro, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

The interior of the physical plant was in good condition and sanitary. Fire extinguisher located in the kitchen was observed to be in compliance and in good repair. Carbon monoxide and smoke detectors were observed to be in good repair.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable and non-perishable food supplies were identified in the garage. Knives were observed to be locked in a hallway and made inaccessible to the residents at this time.