Facility Evaluation Report

On 4/2/2025 LPA Grace Donatoconducted an unannounced annual visit to the facility. LPA met with the administrator Deborah Dahlen and explained the purpose of the visit.

LPA toured the facility inside and outside. While touring the facility it was observed that the temperature was at 69 deg F. Hot water was also tested and temperature was 110 deg F. Only 1 resident currently residing in the facility. All personal belongings are intact. Carbon monoxide monitor is working properly. All fire extinguishers have been checked. Bathrooms were observed to be in good repair equipped with non-skid mats and grab bars. There is also adequate amount of food. 2 days for perishables and & 7 days non-perishable. Sharps and toxic materials are locked. Emergency drills are done quarterly.

Medication review was done and all medications are accounted for and centrally stored medication records are updated. Two staff records and one resident record was reviewed. All staff has criminal record clearance and are associated with the facility. Resident records are checked and all are complete and updated.

Based on records review, Licensee doesn't have an updated administrator certificate.

Licensee to submit Liability Insurance to LPA.

Deficiency of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed with Administrator and a copy is provided with appeal rights.