Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Julius Ervin Javier. During the visit, LPA observed 4 residents and 3 staff.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. LPA measured facility Room temperature was at 90 degrees F using a thermometer. LPA observed the facility thermostat, which indicated the facility temperature was at 89 degrees F. LPA measured facility hot water temperature at 108 degrees F in both resident bathrooms.

Fire extinguisher was serviced in January 11, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on May 20, 2024.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing resident R1 and R3's centrally stored medication log, LPA observed the log was not filled out. ADM stated he did not fill out the log for R1 and R3, but was planning on filling out the logs today. LPA conducted interviews with 2 staff and 2 residents. LPA reviewed 3 resident P&I records.

Deficiencies are being cited during today's visit. This report was reviewed with Administrator Julius Ervin Javier and a copy of the signed report was provided. Appeal rights were provided.