Facility Evaluation Report

Licensing Program Analyst (LPA) Santino Fortes conducted an unannounced annual inspection, and met with Licensee(LC) Acuzena Zipagan. LC stated facility has 3 staff and 6 clients.

LPA toured the facility inside and out. There were 3 resident rooms (shared), 1 staff rooms, 1 living room, family room, and Kitchen. LPA observed resident rooms each with a chair, night stand, sufficient lighting and chest of drawers. Room temperature was 74 * F. Hot water temperature was Bathroom, 119*F, Bathroom _119* F and kitchen 119* F. LPA observed the first aid kit to be complete. Smoke and carbon monoxide detectors functioned properly when tested. 2 Fire extinguishers were serviced on 6/6/24. Staff conducted a fire drill on 11/12/24. Restrooms observed to have non skid flooring. LPA observed 2 days perishable food supply and 7 days non-perishable food supply. Refrigerator temperature observed at 35.6 * F and Freezer temperature 15* F. LPA observed medication storage, knives storage, and cleaning product storage locked and inaccessible to clients in care.

The front and back yards of the facility were inspected. Exits and walkways were unobstructed. Facility has no storage shed.

LPA observed Facility License and Resident Personal rights were posted. LPA reviewed facility records for 3 staff, 5 clients and observed to be complete. LPA reviewed 5 client’s medications, centrally stored medication records and observed to be complete.

No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with LC. This report was reviewed and a copy was provided to LC for signature.