Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Ronaldo Rapisura, Lead Care Giver.

During visit, LPA Marrufo toured the facility inside and out. The facility kitchen and food storage areas had a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA Marrufo observed locked storage areas for sharp objects and cleaning supplies. The first aid kit was inspected and found to be complete.

LPA toured 3 out of 3 resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA Marrufo tested 1 out of 1 carbon monoxide detector and each smoke detector in the hallway, living room and 3 bedrooms. All carbon monoxide and smoke detectors functioned properly when tested. LPA toured the outside area and found the exit to be clear of obstructions.

LPA toured 1 out of 1 facility restrooms and found the restroom had working lights and available soap and paper towels. The water temperature in the bathroom sink was 108 F.

LPA reviewed 5 out of 5 resident Personal and Incidental Money Logs and found them to be balanced. LPA Marrufo reviewed 2 out of 2 Centrally Stored Medication and Destruction Records (only 2 residents take medications) and found them to be complete. LPA Marrufo reviewed 5 out of 5 resident records and observed resident R1's record was missing a Physician's Report and resident R2's record was missing an Admission Agreement and a Physician's Report. LPA reviewed 4 staff records and observed staff S1 was missing a current First Aid certification and staff S2 and S3 were missing LIC9052 Employee Rights forms. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. An Advisory Note was issued. See LIC9102 form for more information. This report was reviewed with Ronaldo Rapisura and a copy of this report and appeal rights were provided.