Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Isabel Jimenez, Administrator.

During visit, LPA Marrufo 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 bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. During visit, the smoke detectors in the hallways and bedrooms and the carbon monoxide detector were tested and functioned properly.

LPA toured two out of two bathrooms. Each bathroom had available soap and paper towels and working lights. The water temperatures in the bathroom sinks ranged from 111 F to 115 F.

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

LPA reviewed four out of four resident records, including Centrally Stored Medication and Destruction Records and Personal and Incidental Money Logs, and found them to be complete. LPA reviewed five staff records and found them to be complete.

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