Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with Designated Administrator Philipp Perez and stated the purpose of the visit.

The facility is licensed to serve adults 60 and over, capacity is 6. All may be non-ambulatory and a hospice waiver for 6. LPA observed 4 residents and 3 staff present, 2 out of 6 residents were not at the facility and 4 out of 6 were at the facility. LPA interviewed 2 Out of 6 residents. 2 Out of 6 was resting.

LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). LPA measured the hot water temperature with a digital thermometer in kitchen and bathrooms, water temperature measured at 128.8°F to 133.3°F which exceeded the requirement based on California Code of Regulations (CCR) Title 22 87303 (e)(2) of 105°F to 120°F.

Bathrooms had grab bars and non-skid mats; resident rooms had adequate storage. Medications were locked and not accessible to residents; first aid kit was complete. Outdoor areas were free of hazards; laundry appliances were functional, and cleaning supplies were secured. Fire, smoke, and carbon monoxide systems were operational; hallways were clear from tripping hazards and well-lit.