Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Shari Lynn Capalla . During visit, LPA observed 2 residents and 4 staff.

LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. 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. Room temperature was at 70 degrees F, and hot water temperature was measured at 108 degrees F in both resident bathrooms.

Fire extinguisher was serviced in June 14, 2023. 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. LPA requested facility drill log. LPA observed the last drill conducted was on the following dates. First quarter of 2023 - 03/25/2023, Second quarter of 2023 -04/18/2023, 05/22/2023. Fourth quarter of 2023- 11/8/2023.

LPA asked ADM for facility staff and resident files. ADM only provided 2 resident files. ADM stated the rest of the files were not at the facility. ADM stated she would get the staff files and resident files as her files are located at her home which is 10 minutes away. ADM left the facility and went to go pick up the missing staff and resident files. When ADM returned (4:15pm), LPA reviewed facility records for 3 staff and 3 residents. LPA requested to review residents medication records at approximately 4:50pm. ADM stated she forgot to bring the centrally stored medication record.