Facility Evaluation Report

At 8:00am on 03/25/2025, Licensing Program Analysts (LPA's) Jeffries and Haner-Tomaso arrived unannounced to the facility to conduct the annual facility inspection. LPA's met with Administrator Thelma Tablada announced who they are and the reason for there visit.

Administrator and LPA's conducted a physical tour of the facility. This is a 6 bedroom 5 bathroom home with a side and back yard with ample space for residents and visitors. Four of the bedrooms are single resident occupancy and one bedroom is double resident occupancy and one bedroom is a staff bedroom. There is a living room, dining room and kitchen with and annectent office and nook. LPA's noted that the medications are stored and locked in the cabinet in the office adjacent to the kitchen and the complete first aide kit is also located in this office area. Emergency water is located in the garage and there is a staff room with day bed and chairs for staff. LPA noted that the facility has at least 2 days of perishable food supply and at least 7 days of non perishable foods on hand for 6 residents and staff. LPA noted several fire extinguisher in the facility and garage that were all primed in the green reading. LPA's tested smoke detectors and carbon monoxide detectors to all be functional and working. LPA's noted that all passage ways are free and clear of obstacles. LPA's conducted a sample medication audit. LPA's reviewed all staff and resident files. LPA's noted and cited for no lamp or lighting fixture in Bedroom #3 (CCL,87303(d)), black mold in the bathtub in bathroom number #1 (CCL, 87303(e)(6)), Staff bedroom was left unsecured with vitamins in view and unsecured. (CCL, 87309(c)), and no recent documented fire drill. (H&S 1569.695(c)). LPA's conducted a full review of the annual facility care tools.

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