Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Cyril Inneh.

During visit, LPA toured the facility inside and out. During visit, LPA toured 12 out of 12 resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks were 115 F and 116 F.

LPA toured the kitchen area and food storage areas. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed there to be a locked closet where cleaning supplies are stored. LPA toured the outside area of the facility and found the outdoor exit to be clear of obstructions. During visit, ADM triggered the smoke/carbon monoxide detector system and it functioned properly when tested. LPA observed the first aid kit and found it to be complete.

LPA reviewed resident records for six residents. Residents R1, R2, and R3 were missing the Safeguard for Property and Valuables Form. LPA reviewed the resident Personal and Incidental Money Logs and found them to be complete. During visit, ADM stated that the Centrally Stored Medication Logs for March had not been updated.

LPA reviewed staff records for six staff. Staff S1 was missing an LIC503 Health Screening Form.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with ADM Cyril Inneh and a copy of this report and appeal rights were provided.