Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Madonna Dumantay. During the visit, LPA observed 4 residents and 3 staff.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

While touring resident bedrooms, LPA observed staff bedroom (located between room 3 and receiving room), sliding screen door is damaged on the bottom left corner and that portion of screen is no longer attached to the frame. While touring facility master bedroom, LPA observed the window did not have a screen. LPA also observed the sliding screen door for the master bedroom did not have a sliding screen door. (Photographs were taken) While touring the facility family room, LPA observed the door between, the family room and the receiving room was damaged. LPA observed 4 indentations on the door. (Photographs were taken)

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 117 degrees F in both resident bathrooms.

Fire extinguisher was serviced in April 18, 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 March 2, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff (S1) and 1 residents (R1).

Deficiencies are being cited during today's visit, see LIC809-D. This report was reviewed with Administrator Madonna Dumanty and a copy of the signed report was provided.