Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Bory Kham and Daniella Caballero.

During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen 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 toured the resident communal areas and 9 resident bedroom areas. Each bedroom had working lights and available bedding and clothing storage areas.

LPA observed 6 resident bathrooms. Each bathroom had available soap and paper towels. The water temperatures in the bathrooms ranged from 70 F to 130 F.

LPA toured the outside area and observed the exits to be clear of obstructions. LPA reviewed the Centrally Stored Medication and Destruction Records for six residents and found them to be complete. LPA reviewed six resident records and found them to be complete. LPA reviewed six staff records and found them to be complete.

During visit, staff tested the smoke detection system and it functioned properly when tested. LPA tested the carbon monoxide detector and it functioned properly when tested.

See LIC9099-C page for more information. Page 1 of 2.