Facility Evaluation Report

Licensing Program Analyst (LPAs) Mita Partoza and Marcella Tarin conducted an unannounced complaint investigation and observed deficiencies while conducting inspection. A case management was initiated for the deficiencies that were found during the complaint investigation that is not related to the complaint.

During the tour LPAs observed 3 resident R1-R3, and 1 staff. R1, R2 were watching TV in the living room, and R3 was in their bedroom. LPAs observed staff (S1) was in the kitchen preparing food. LPAs observed Licensee in staff room with S1s grandchild under the age of 5. R4 arrived after an hour.

LPAs toured the interior and exterior of the facility and observed that the facility required maintenance, 4 bedroom were observed to have unknown powder residue on the floor. ADM stated it was sprayed by the exterminator to prevent bedbugs from repopulating. LPAs observed dust and cobwebs throughout the facility, a broken window screen outside bedroom #4, an uncovered waste basket in bedroom #1 with unknown stain brown in color and splattered on the wall next to the waste basket. LPAs observed Comet cleaning product in a bathroom, accessible to residents in care.

During the visit, LPAs requested for one resident record file and observed R4s file did not contain a current LIC602, the last assessment recorded was on 9/7/2020. ADM stated that he/she was not aware that LIC 602s (Physician's Report) needs to be updated. LPAs provided a technical assistance to ADM regarding updating medical assessment as required by the Department. During the facility's annual inspection on 12/26/2024, deficiencies were issued for records not being available for LPAs review.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. An exit interview was conducted with Administrator Dhorydell Sison and a copy of the report and appeal rights were provided.