Facility Evaluation Report

On 7/27/2024 at 2:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced, required 1 year inspection at the facility and met with the designated administrator (DADM) Annabelle Esperanza. At the time of the visit, DADM stated that licensee/administrator (LIC/ADM) Debra Hall is currently unable to come to the facility due to physical injury requiring rest.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over. 6 may be non-ambulatory. The facility has a waiver for 3 hospice care. The facility's has 4 residents (R1 to R4) that have neurocognitive impairment. 3 staff were present at the time of the visit. 4 residents were present at the facility. 2 of 4 were in the dining area. 2 of 4 residents are in the bedroom and 2 of 4 are under hospice care.

At 2:15 p.m.. LPA with DADM, toured the facility inside and outside, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 78 degrees F.

LPA and DADM toured the 4 resident bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. Residents uses an alarm system to alert staff if assistance is needed and a motion sensor alarm on the bed. ADM stated the facility has a night on call staff if a resident is awake, and staff stays with the resident.

LPA observed that the facility has a wall pull fire alarm system connected to the fire department emergency line and a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. page 1 of 3 (SEE LIC 809C).