Facility Evaluation Report

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

LPA checked 5 resident files and 5 staff files.

LPA toured the facility with ADM. License, Administrator Certificate and Personal right posters were observed in the facility. There are two staff live-in rooms, 3 resident shared rooms, and 2 restrooms in the facility. Grabbing bars and Non skid pads were observed in the bathrooms. 3 staff and 5 residents were observed in the facility. LPA toured the kitchen, dining room, family room, and garage. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The room temperature was 74 degree F, and the hot water temperature was 110 degree F. The temperature of the refrigerator was measured at 33 degree F, and the temperature of freezer was measured at -5 degree F. Medication cabinet was observed locked. Cleaning chemical products cabinet under the sink were observed locked. Knives cabinet was observed locked. Fire extinguisher was serviced on 10/24/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. First aid box, flash light for emergency, and night light were observed in the facility. The facility fire and emergency drill was conducted on 10/5/2023.

LPA toured backyard with ADM. No obstacles were observed blocked the walkway in the backyard. Gnats were observed around the garbage cans placed at the side yard by the building of the facility.

ADM agreed to update the Infection Control Plan and send to LPA. Deficiencies were noted today. See LIC809-D.

Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.