Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Fatemeh Kaykha.

During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed there to be locked drawers for medications and sharp objects. LPA toured the food supply in the kitchen and garage area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the first aid kit to be complete.

LPA toured three out of three bedrooms and observed there to be working lights and available bedding and clothing storage areas. LPA toured two out of two bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured at 115 F and 116 F.

LPA tested the smoke detectors in the living room, hallway, and three out of three bedrooms. Each smoke detector functioned properly when tested. LPA tested the facility carbon monoxide detector and it functioned properly when tested.

LPA toured the outside area of the facility and observed the exterior exit to be clear of obstructions.

LPA reviewed Centrally Stored Medication and Destruction Records, Personal and Incidental Money Logs, and resident records for four out of four residents and all the records were complete. LPA reviewed 5 staff records and found them to be complete. The Emergency Disaster Drill Log indicates the last drill was conducted on 12/13/2024.

No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Fatemeh Kaykha and a copy of this report was provided.