Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's requires - 1 year annual inspection. LPA met with Administrator, Armando Guba.

During visit, LPA toured the facility to include the resident bedrooms, bathrooms, living room, kitchen, garage and backyard. All fire exit routes were free and clear of obstruction.

There were 2 staff present to 3 residents. 2 out of 3 residents are under hospice care.

The 2 staff present are fingerprint cleared, but 1 out of the 2 staff are not associated to the facility. Administrator admitted that 1 staff member was not associated to the facility as the staff was added to the schedule last minute. The Administrator immediately submitted the LIC9182 form to the Department to associate the staff to the facility roster. A technical violation was provided per Section 87355(e)(3) reminding the facility to ensure all staff working are requested a transfer of a criminal record clearance prior to work.

Facility temperature maintained at 78 degrees F. Fire extinguisher last serviced on 08/01/2025. Emergency lighting observed in the hallway. Smoke detector and carbon monoxide detector was tested and observed operable. Bathroom hot water temperature maintained at 117.8 degrees F. The bathroom shower observed with non-slip mats and grab bars. Facility has at least 2 days worth of perishables and 7 days worth of non-perishables foods. Refrigerator temperature maintained at 35.6 degrees F. Freezer temperature maintained at -4 degrees F. Page 1 of 4.