Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Rubenita Sandoval.

LPA observed 3 staff and 1 resident in the facility. 4 residents went to day program.

LPA reviewed 3 resident files and 3 staff files.

LPA toured the facility inside out with ADM. License, ADM Certificate, and Personal Rights posters were observed in the facility. Family room, kitchen, dinning room and three restrooms were inspected. Bar and non skid mats were observed in the restroom. 4 single resident bedrooms, 1 shared resident bedroom and laundry room were inspected. One office was observed in the facility. Two bedrooms were observed added in the office. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 72 degree F, and hot water temperature was at 119 degree F in facility. The temperature of the freezer was at -20 degree F, and the temperature of the refrigerator was at 25 degree F.

Fire extinguisher was serviced on 01/11/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Three storage rooms were observed at the backyard.

First aid box, night lights, and flash lights were observed in the facility. The last time the facility conducted the fire drill was on 9/8/2024. Deficiency noted today. See LIC 809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.