Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Aileen Calicdan, Designated Administrator.

During visit, LPA Marrufo toured the facility inside and out. During visit, LPA toured the kitchen area and observed there to be locked cabinets for medications, sharp objects, and cleaning supplies. LPA 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 reviewed the first aid kit and found it to be complete.

LPA toured three out of three resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detectors in the dinning room, hallway, and three out of three resident bedrooms and found them to function properly when tested. LPA tested one out of one carbon monoxide detector and observed it to function properly when tested.

LPA toured the outside area of the facility and found the outdoor exit was clear of obstructions.

LPA reviewed resident records for six out of six residents, including Centrally Stored Medication and Destruction Records and Personal and Incidental Money Logs, and found them to be complete. LPA reviewed four staff records and found them to be complete.

See LIC809-C page for more information. Page 1 of 2.