Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds. This one level facility consists of 6 private client rooms--4 of which have private half or full bathrooms--2 staff rooms, bath/shower room, living/dining area, kitchen, and attached garage. Three residents currently receive hospice services. There is a detached storage shed in backyard. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. There is no signal system in place, as facility employs awake overnight staff. Carbon monoxide detector is tested and operable. First-aid kit is maintained and complete.

A staff room above 1-car garage has 3 beds and rear room on left side has a bunk bed and half bathroom. The backyard is fenced and accessible by 5 bedrooms with exit doors.

Medications are stored in locked hall closet. Chemicals and cleaners are stored in garage and locked detached storage shed.

An updated Disaster and Mass Casualty Plan is posted, and copy is given to LPA. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed.

Eli Ermitano is a certified RCFE administrator (x10/24) that oversees facility operations.

The following information is requested to be submitted to CCL by 6/28/24:

Current proof of liability insurance for $1 million per incident and $3 million in annual aggregate.

Deficiencies of the California Code of REgulations, Title 22 are cited on a following page. See also Technical Advisory Notes--3 pages.