Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Frances Grace Locsin, Administrator.

During visit, LPA toured the facility inside and out. LPA toured the kitchen area and 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 the first aid kit and found it to be complete.

LPA toured three out of three resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks ranged from 110 F to 116 F.

LPA toured six out of six bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detectors in six out of six resident bedrooms and in the hallways. Each smoke detector functioned properly when tested.

LPA toured the outside area and observed both exits to be clear of obstructions.

LPA reviewed six out of six resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed four staff records and found them to be complete.

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