Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff member Lina Agonoy (S1). S1 contacted facility Administrator(ADM) via phone call and stated she could not come to the facility. ADM stated S1 is her Administrator Designee and could sign on her behalf. During the visit, LPA observed 0 residents and 1 staff.

LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 4 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.

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 74 degrees F, and hot water temperature was measured to range from 107-109 degrees F in both resident bathrooms.

Fire extinguisher was serviced in September 7, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on March 14, 2024.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. LPA conducted interviews with 1 staff and 0 residents. Residents were attending day program during LPA's visit.

No deficiencies cited during today's visit. This report was reviewed with Staff member Lina Agonoy and a copy of the signed report was provided.