Facility Evaluation Report

At 12:05pm on 01/07/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual facility inspection. LPA met with Administrator, Amelita I. Aquino announced who he is and the reason for the visit.

LPA conducted a tour of the facility which consist of 4 resident bedrooms, 1 staff bedroom, 3 bathrooms, living room, kitchen, dining room and outdoor area in back with shade for residents and visitors and a garage. LPA noted that there are smoke detector in each resident room and a new carbon monoxide detector in the kitchen. LPA observed the fire extinguisher primed in the green and currently tagged for service. LPA noted that all hallways and exits are free and clear of obstructions and the facility was clean and in good repair. LPA noted that a review of the Centrally Stored Medication Records (CSMR) was conducted. Medications are stored in a locked cabinet located in the dining room area. LPA noted that the water temperature in the facility was measured within regulation range of 105*-120*(f). LPA noted that he observed at least two days of perishable and at least seven days on non perishable foods on hand. LPA noted that chemicals were locked in the closet above the washer and dryer also in the dinning room area. LPA noted that the facility appeared to be clean and in good repair. LPA noted that bedrooms had appropriate linin and storage. Each room had a working lamps. LPA conducted a staff and resident file review. LPA reviewed facilities Emergency Disaster Plan and Infection Control Plan. LPA noted that bedroom #4 has a sliding door leading to staff bedroom and there are two different facility sketches associated with the facility and the fire inspection does not decimate which facility sketch is accurate. Administrator to stay in CCLD regulation compliance has scheduled for slider to be permenatly closed per city of Paso Robles approval and new fire inspection will be requested at that time that door being covered is completed. LPA cited for personal accommodations, using resident room as passage [87307(a)(2)(C).] Full care tools modules for annual facility inspection was conducted. No other citations issued.

Exit interview, report read, appeal rights and report provided.