Facility Evaluation Report

Licensing Program Analyst (LPA) Mita Partoza conducted an unannounced required annual inspection to the facility. LPA met with administrator (ADM) Marie Jan Foronda-Cayabyab and 5 staff. 15 clients were present during the visit and 15 out of 15 are ambulatory.

During visit, LPA toured the facility to include the living room, dining room, kitchen, bedrooms, bathroom, storage area, and backyard. Staff room was inspected, 2.5 bathroom were inspected. The room temperature measured at 68-75F.

LPA observed there is ample amount of perishable and non-perishable food supply for residents and staff as required by regulation. Toiletries such toilet paper, paper towels, toothpaste are inspected and found to be in ample supply. Toxic materials such as laundry detergent, disinfectant are inaccessible to residents (locked in a cabinet).

All designated emergency exits and passage ways are clear from obstructions.

Staff and Administrator were reminded about infection control plan.

LPA requested the following documents, staff roster and resident roster. LPA discussed required documents with the administrator and submit to LPA by 1/30/2024.

Required annual inspection will be continued at a later date. No deficiencies were cited per California Code of Regulations Title 22 during today's visit. This report was reviewed with administrator Marie Jan Foronda-Cayabyab and a copy was provided.

This report was inadvertently written under the wrong facility profile and is meant for PARKSIDE VILLA INC. # 435202647 . This report is amended and reviewed with ADM Marie Jan Foronda-Cayabyab. Copy was provided.