Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrative Assistant (AA) Ernie Manaois. During visit, LPA observed 4 residents and 1 staff.

LPA toured the facility inside out with staff S1 which included; the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. 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 closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 117 degrees F in both resident bathrooms.

While touring the home LPA observed multiple windows, without screens. LPA observed resident bedrooms 4, Bedroom #3, & the dinning room window without window screens. While touring the home LPA observed the shower walls in the bathroom between Bedroom #4 and Bedroom #3 had soap scum stains. LPA observed ice build up in the facility fridge, in front of the oven. LPA also observed duct tape holding up the shelves of the fridge as well. LPA observed the fan in the dinning room had clumps of dust on the fan. LPA observed several empty cardboard trays in the backyard. LPA observed an empty plastic bad and a empty cloths basket on the ground. LPA observed two cobwebs in bedroom #4; one in the corner of the room, directly perpendicular to the door. LPA also observed a cobweb above the closet. The door to bedroom #4 also had an indent the size of a door knob. LPA observed one of the light panels above the kitchen was not working, the light directly above the fridge and oven area. (LPA took photographs of all LPA's observations.)

Fire extinguisher was serviced in June 12, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by AA, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 5, 2024. Page 1 out of 2.