Senior Care Records.

Facility Evaluation Report

Lsa - Home #2, Santa Clara04/10/2024Licence 435201681

Capacity6
Census4
Date signed04/10/2024 04:10:25 PM
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Program Manager (PM) Felicia Lehner . During the visit, LPA observed 4 residents and 3 staff.

LPA toured the facility inside out with PM which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The 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 storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 114 degrees F in resident bathrooms.

Fire extinguisher was serviced in October 17, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by PM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on April 4, 2024.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. LPA conducted interviews with 1 staff and 2 residents.

No deficiencies cited during today's visit. This report was reviewed with Program Manager (PM) Felicia Lehner. PM stated S1 could sign on her behalf. A copy of the signed report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction