Facility Evaluation Report

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management inspection of the facility for compliance. LPA met with Licensee/Administrator Bernelette Taa and stated the purpose of the visit.

The purpose of this inspection is to ensure that the facility is in compliance with Title 22. LPA reviewed with the licensee/administrator regarding the recommendations discussed during NCC meeting on 7/26/2024.

LPA toured the facility inside and outside with the Licensee to include resident rooms, kitchen, living room, and back yard. LPA observed the facility to be clean, safe, sanitary and in good repair for the safety of residents, staff and visitors.

LPA observed door alarms at the top of the living room sliding glass door, top of the door in the hallway leading to the backyard, and on the wooden gate in the back yard on the side of the house. All door alarms functioned properly (audible alarm) when tested by the Licensee.

LPA reviewed 3 staff records. 3 out of 3 staff records have fingerprint clearance, medical assessment with TB result, and staff training. LPA reviewed 4 resident records. 4 out of 4 resident records have updated service plans, physician's reports.

LPA reviewed the LIC 500 and facility has sufficient coverage for the number of residents in the facility.

No deficiencies were cited during today's inspection per Title 22 Code of Regulations and an exit interview was conducted with the Licensee/ Administrator Bernelett Taa. A signed copy of the report was provided.