Facility Evaluation Report

LPA Jeung toured facility and grounds of this 2 story facility. There are 8 bedrooms on the 1st floor and 11 bedrooms on the 2nd floor. All rooms are private with private half baths, and ground floor rooms each have direct exits to exterior. There is a shower room on each floor. There are 3 stairwells and one elevator. Dining room, kitchen, duty station/medication room and living room with TV are on the ground floor.

On the second floor, there is a crafts/activity room, small library room, laundry room and beauty salon. Medications and toxins are secured and inaccessible to clients. Supplies of food preparation and service items, perishable and non-perishable foods, bed and bath linens and PPE are maintained. Hot water temperature tested randomly in first and second floor rooms. There is an emergency call system installed in private bathrooms, and another pendant alarm that can be worn by residents; an audible signal is transmitted to a monitor in the living room/manager's desk on ground floor, and caregivers are alerted via walkie talkies.

Staff and client files are reviewed. Four residents are currently receiving hospice services. Neeru Verma is a certified RCFE administrator (x 1/27) that oversees facility operations, but certificate is not available for review.

Due to time constraints, citations for Type B deficiencies will be issued at a later date, and medication records will be reviewed then.

The following information/forms are requested to be sent to CCLD BY 12/22/25:

- Facility sketch (LIC999) with corrected room numbers

Type A deficiencies of the California Code of Regulations, Title 22, are cited on a following page.