Facility Evaluation Report

Licensing Program Analysts ( LPAs) Steve Chang and Mita Partoza conducted an unannounced case management inspection visit and met with Administrator (ADM) Jean Jose. ADM stated that licensee is not in the facility is out of the country approximately beginning of July, 2024 and have not returned since then.

ADM stated that there are currently 6 residents in the facility. 1 Out of 6 is at the hospital and 5 out 6 are present and resting in their room. 1 out of 6 is ambulatory, 2 of 6 are under hospice care. 3 out 6 are non-ambulatory. 1 out of 6 is in the hospital.

LPAs stated the purpose of the visit is to conduct a case management visit ensure that facility is compliant with California Code of Regulation (CCR) Title 22 such as the condition of the physical plant, staffing requirement, the living condition of the resident, and if the garage is being used as a room to accommodate a resident.

LPA toured the facility inside and outside with ADM such as living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. 6 of 6 resident's room are sanitary, organized and has sufficient storage. One of the resident's restroom sink drawer cabinet was not closing properly and can be a tripping hazard. Bedroom #6 at the end of the hallway has a broken window glass and is missing a window screen. S1 stated that there are window air conditioner system for each room. However R1 does not want the window air conditioner. S1 stated that the screen window will be re-installed. The facility is equipped with working smoke and carbon monoxide alarm system.

The front yard and backyard were inspected. LPAs observed the following, at the front yard is a vehicle that is not operational covered by a gray tarp. S1 stated that the vehicle has been parked for a number years prior to her being employed at the facility, LPAs toured the facility garage and observed a sleeper couch inside and clothing items. S1 stated that the staff use the garage as their place to rest, while the licensee is out of the country. LPAs observed a functioning bathroom with shower inside the garage used by the staff.