Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Hector Marquez, Program Coordinator.

During visit, LPA Marrufo toured the facility inside and out. The facility bathroom had available soap and paper towels. The water temperature in the bathroom sink measured at 110 F. The outdoor exit was clear of obstructions.

LPA reviewed 5 resident records and 5 staff records. Resident R1's record was missing an Admission Agreement. Staff S1 was missing a current first aid certification. Staff S2's record was missing an LIC9052 Employee Rights form. Staff S3 was missing an LIC503 Health Screening form. Staff S4's record was missing an LIC501 Personnel Record and an LIC9052 Employee Rights form.

The last documented Emergency Disaster Drill was conducted on 06/10/2024. During visit, staff stated to not have any record of the last smoke detector test.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information. Advisory Notes were issued. See LIC9102 for more information.

This report was reviewed with Hector Marquez and a copy of this report and appeal rights were provided.