Facility Evaluation Report

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

During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and and the pantry areas. 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 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. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The showers had anti-slip mats. The water temperatures in the bathroom sinks ranged from 114 F to 115 F.

LPA tested the smoke and carbon monoxide detectors in the hallways and bedrooms and each detector functioned properly when tested.

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

LPA reviewed four out of four resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed two staff records and found them to be complete.

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