Facility Evaluation Report

Licensing Program Analysts (LPAs) David Marrufo and Tracy Pham conducted an unannounced Required 1 Year visit and met with Lourdes Cera, House Manager.

During visit, LPAs toured the inside and outside of the facility. LPAs toured the facility kitchen and observed there to be a food supply of at least two days and a perishable food supply of at least 7 days. Sharps and medications were locked in secured areas. There was a first aid kit in the facility. LPAs observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

The facility bathroom had available soap and paper towels. The shower had grab bars and a shower chair. The water temperature was measured at 115 F.

Facility smoke detectors were tested and found to be functioning when tested. Three out of three resident bedrooms had available bedding, drawers, and functioning lights. However, resident R1's bedroom did not have a bed. Staff showed LPAs a mattress, blankets, and hammock in the outside rear porch area which they said R1 uses to sleep outside. LPAs spoke with Administrator Christia Mendoza who stated R1 has irregular sleeping hours and behaviors. She stated R1 will sleep outside at night on the mattress or hammock and sometimes bring the mattress in to sleep as well. LPAs observed that two out of two bedrooms had objects obstructing the sliding door exits.

LPAs reviewed facility records for staff and residents. LPAs reviewed resident medications and Personal and Incidental Money logs.

See LIC809-C for more information. Page 1 of 2.