Facility Evaluation Report

On 6/07/2024 at 1:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management for Annual continuation and was met by Designated Administrator (DADM) Rita Garcia. The Administrator(ADM) Yiweh (NIcole) Shih was not present at the time of the visit. DADM called ADM and asked if ADM can come to the facility. ADM stated he/she is not available due to prior commitment.

During today's visit LPA observed that 6 out of 6 residents are resting and are currently in their respective bedrooms. 4 out of 6 residents have neurocognitive impairment, 2 out of 6 has mental impairment.

On 6/4/2024, LPA with DADM toured the facility inside and out, such as kitchen, dining, living area, backyard, resident's room, bathrooms, entry way, staff room and office. The facility has 5 resident bedroom, 1 of the 5 bedroom is shared and 4 are private. LPA observed a sign on the entry way that oxygen is in use. DADM stated that the oxygen is used by 1 Out of 6 resident (R1) on as needed basis. LPA observed a sign on the entry way that oxygen is in use. DADM stated that the oxygen is used by 1 Out of 6 resident (R1) on as needed basis.

LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 70.1 degrees F.

LPA observed the kitchen to be organized, and sanitary with working appliances. Knives were kept in a secure locked area and not easily accessible to residents. The laundry room has a lock, and staff room is The facility has 2 days of perishable food and 7 days of non-perishable food. page 1 of 3