Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Michael Vu.

During visit, LPA Marrufo toured the facility inside and out. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed there to be locked cabinets and drawers for cleaning supplies and sharp objects.

LPA Marrufo toured three out of three resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured between 108 F to 118 F. The bathroom showers had anti-slip mats and shower chairs.

LPA toured five out of five resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detector system and it functioned properly when tested. LPA tested the carbon monoxide detector and it functioned properly when tested.

LPA toured the outside area of the home and the outdoor exits were clear of obstructions.

LPA reviewed the Centrally Stored Medication and Destruction Records (CSMDRs) of five out of five residents. Resident R1's CSMDR had one medication that did not have it's prescription number recorded. R2's CSMDR had four medications that were not recorded. Staff recorded the missing medication information during visit. See LIC809-C page for more information. Page 1 of 2.