Facility Evaluation Report

At approximately 09:00 AM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by LVN caregiver Pam Deleon who has Designation of Facility Responsibility (RP). Administrator Jasmine Aliscad was called and informed of inspection and arrived later at 09:50 AM.

Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Two residents were present and one was away with Administrator at an assessment and another resident was away at day program. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents and has a hospice waiver for one (1) and is vendorized with North Bay Regional Center (NBRC).

At approximately 9:30 AM, LPA initiated a tour of the facility with RP and observed the following: Facility is a one story home, was a comfortable temperature, free from odors, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene products, incontinent care supplies, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency food and water supply. In addition each resident has a dedicated emergency go-bag. There is a shaded seating area with a electronic retractable awning in the backyard with outdoor space and stainless steel Bar-B-Que for use. In addition, facility has wide wheelchair ramps in front and back of the home.

LPA observed 1 locked shed in the backyard which LPA inspected and observed the contents to consist of PPE supplies, extra resident care equipment, holiday decorations, and a large emergency generator.