Facility Evaluation Report

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

During visit, LPA toured the inside and outside of the facility. LPA toured 3 out of 3 resident bedrooms and observed each bedroom to have working lights and available clothing storage and bedding. LPA tested the carbon monoxide detector in the hallway and it functioned properly when tested. LPA tested the smoke detectors in 3 out of 3 resident bedrooms and in the hallway and all smoke detectors functioned properly when tested.

LPA toured 1 out of 1 resident bathroom. The bathroom had working lights and available soap and paper towels. The water temperature in the bathroom sink measured at 119 F. LPA toured the kitchen area and observed locked storage areas for sharp objects and cleaning supplies. LPA toured the facility food supply in the kitchen area and garage area and found there to be a perishable food supply of at least 3 days and a non-perishable food supply of at least seven days.

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

LPA reviewed the Personal and Incidental Money Log, the Centrally Stored Medication and Destruction Record, and the Resident Record for 4 out of 4 residents and found them to be complete. 4 staff records were reviewed and found to be complete.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Isabel Jimenez and a copy of this report was provided.