Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with staff member S1, Catherine Koen . During visit, LPA observed 6 residents and 2 staff.

LPA toured the facility inside out with S1 which included; the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area and second floor of the facility was also inspected. Front yard and backyard were inspected. LPA observed the garage being used as a storage area. There was no obstruction to block the walkways.

Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 118 degrees F in both resident bathrooms.

Fire extinguishers were serviced in November 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 5, 2023.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 to S2) and 3 residents (R1-R3). LPA requested to review 3 resident P&I records. S1 stated he/she was doing a review of the resident's P&I records and left the binder with the funds back at his/her home in Morgan Hill.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Staff member, Catherine Koen . Appeal rights were provided.