Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Tyrone Vega.

During visit, LPA toured the facility inside and out. During visit, LPA toured the kitchen area and observed there to be locked cabinets for sharp objects and medications. LPA 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 toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks were 116 F.

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

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

LPA reviewed the Centrally Stored Medication and Destruction Records (CSMDR) for residents R1-R5. Resident R1 had one medication missing from the CSMDR and R2 had two medications missing from the CSMDR. LPA reviewed the resident records of R1-R5 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.