Facility Evaluation Report

LPA Jeung toured facility and grounds of this 2-story facility. There is one elevator and 2 stairwells, 7 shared rooms on ground floor and 17 shared rooms on second floor; all rooms have a private bathroom. On the ground floor, there are 2 offices, medication room, kitchen, living and dining rooms. On the second floor, there is a common TV room and laundry room. Medications are secured in medication room and toxins are secured in locked maintenance room on ground floor. Supplies of food preparation and service items, perishable and non-perishable foods, bed and bath linens and PPE are maintained. Hot water temperature tested randomly in first and second floor rooms within range of 105 and 120 degrees F. There is an emergency call system installed in each bedroom and bathroom, that transmits audible and visual signal to reception desk on ground floor, as well as to pagers carried by caregivers.

Client files are reviewed. Mary Ann Lucero is a certified RCFE administrator (x10/27) that oversees facility.

Staff records and medication records will be reviewed at a later date, due to time constraints.

The following forms/information are requested to be submitted to CCLD BY 12/17/25:

- Affidavit regarding Client Cash Resources (LIC400)

- proof of current surety bonding, if applicable

Proof of current liability insurance is given to LPA today.

Deficiencies of the California Code of Regulations, Title 22 are cited on following pages. See Advisory Notes for technical violations--2 pages.