Facility Evaluation Report

Licensing Program Analysts (LPAs) David Marrufo and Santino Fortes conducted an unannounced Required 1 Year visit and met with Armando Guba, Administrator.

During visit, LPAs toured the facility inside and out. LPAs toured the facility kitchen area. LPAs observed a prescription inhalation mediation left unsecured on the kitchen island surface. Staff placed the unsecured medication in the locked medication storage cabinet during visit. LPAs observed an uncovered container containing a cut lemon and another food item inside the refrigerator. Staff removed the uncovered container from the refrigerator during visit. LPAs observed the locked cabinet where sharp objects are stored. LPAs observed the locked storage cabinet used to store medications and records. LPAs observed the first aid kit and found it to be complete.

LPAs toured 2 out of 2 resident bathrooms and observed each bathroom had working lights and available soap and paper towels. The showers in each bathrooms had grab bars and anti-slip mats. The water temperatures in the bathroom sinks measures at 118 F and 115 F.

LPAs toured 5 out of 5 resident bedrooms and found each bedroom to have working lights and available bedding and clothing storage areas. LPAs tested the smoke detectors and carbon monoxide detectors in the hallways and each resident rooms and found them to function properly when tested. LPAs toured the outside area and found the exits were clear of obstructions. LPAs reviewed the Centrally Stored Medication and Destruction Records (CSMDRs) for 4 out of 4 residents. Resident R1 had 2 medications missing from the CSMDR. Resident R2 had 2 medications missing from the CSMDR. R3 had 5 medications missing from the CSMDR and 2 medications did not have a prescription label. R4 had two medications missing from the CSMDR. LPAs reviewed 4 out of 4 staff records. R1-R4 were missing Safeguard for Property and Valuables Forms and R3-R4 were missing Pre-Appraisal Forms. LPAs reviewed 1 out of 1 staff records and found it to be complete. See LIC809-C for more information. Page 1 of 2.