Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Administrator Mauna Morris.

During visit, LPA toured the facility inside and out. LPA checked 2 out of 2 carbon monoxide detectors and each detector functioned properly when tested. LPA Marrufo obtained a copy of the fire alarm inspection invoice dated 05/10/2024 from a fire alarm system maintenance contractor and an Inspection Report from local fire department dated 07/17/2024 which stated the facility was in compliance. LPA toured the facility kitchen area and found there to be a locked cabinet for cleaning supplies. LPA toured 3 out of 3 resident bathrooms and found the water temperatures to be between 113-114 F. LPA toured the outside area and found the exits to be clear of obstructions.

LPA reviewed resident records for 5 residents. Resident R1 was missing an Admission Agreement and an LIC613 Personal Rights Form. Resident R2 was missing an Admission Agreement and Consent Form for Medical Treatment. LPA reviewed 5 staff records. Staff S1 was missing an LIC503 Health Screening Form.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information. Advisory Notes were issued. See LIC9102 pages for more information. This report was reviewed with Administrator Mauna Morris and a copy of this report and appeal rights were provided.