Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year annual visit and met with Chris Shuster.

During visit, LPA Marrufo toured the facility inside and out. LPA toured 4 hallway bathrooms and observed each bathroom to have working lights and available soap and paper towels. The water temperatures in the bathroom sinks ranged from 109 F - 114 F. LPA toured the facility kitchen area and observed the kitchen to have a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA toured the outside areas and observed the exits were clear of obstructions.

LPA reviewed the resident records and Centrally Stored Medication and Destruction Records (CSMDR) for 5 residents. All 5 reviewed CSMDRs were found to be complete. Resident R1 and R2's resident records were missing Safeguard for Property and Valuables forms. LPA reviewed the staff records for five staff. Staff S1 was missing a current first aid certification.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information.

This report was reviewed with Chris Shuster and a copy of this report and appeal rights were provided.