Facility Evaluation Report

Licensing Program Analysts (LPAs) Simi Rai and Manuel Monter conducted an unannounced annual inspection visit and met with Licensee Violeta Dumo.

During visit, LPAs toured the inside and outside of the facility. The facility has a structure at the backyard that is not being used as a living space and LPAs observed the space is being used for storage. LPAs toured the facility kitchen and observed at least 2 days of perishable food supply of at least 7 days of nonperishable food supply. Sharps and medications were locked in secured areas. There was a first aid kit in the facility. LPAs observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

The facility bathroom had available soap, paper towels, and trash cans with lids. The showers had grab bars, non-skid mats, and shower chairs. The water temperature in the bathroom sinks ranged from 115.96F - 116F. The water temperature in the kitchen sink was 115.9F . Fire extinguisher were observed and were inspected on May 2022.

Facility smoke and carbon monoxide detectors were tested and found to be in functioning condition. Three out of three resident bedrooms had available bedding, drawers, and functioning lights. LPAs reviewed facility records for four staff and three residents. LPAs reviewed resident medications and central stored medication records. LPAs interviewed 2 staff and 1 resident.

Technical Violation were issued. See LIC9102 pages for more information.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Licensee Violeta Dumo. A copy of the report was provided.