Facility Evaluation Report

On July 18, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Caregiver, Rolly Bautista and explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility. There are six resident bedrooms and one staff bedroom. All resident rooms were observed to be clean and odor-free with half bathrooms. LPA observed two full bathrooms equipped with grab bars, non-skid mats, and in good repair. Water temperature throughout the facility measured between 107-110 degrees F. Extra linen was observed to be present. First aid kit was observed to be complete.

Dining room was observed free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed seven day non-perishables but not two day perishables. Medications, sharps, and chemicals were observed unlocked an accessible to residents in care.

Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of

March 2025. Emergency drills are being conducted every three month. LPA reviewed 5 resident records and 5 staff records. Medication review was done and all medications are accounted for.

Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with the Administrator. A copy of this report and the appeal rights were provided.