Facility Evaluation Report

At approximately 1:10 PM, Licensing Program Analyst (LPA) Star Stevenson arrived announced to BEGIN a required 1-year annual inspection and was greeted by caregiver Irene Llantero who has Designation of Facility Responsibility(RP). RP called licensee Omar Chiong who arrived at approximately 1:30 PM to assist with today's portion of the annual inspection. Facility is a Residential Care Facility for the Elderly (RCFE) licensed for six (6) residents, 6 of which can be non-ambulatory with a hospice waiver for three (3). Currently there are six (6) residents in care, two (2) of which are receiving hospice services.

At approximately 10:15 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Kitchen was observed to have locked drawers for sharps and toxins and the storage of foods were appropriated.

Smoke detectors and Carbon Monoxide detectors were tested and found to be operational.

Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. Bathroom were observed to have grab bars and locking drawers for toxins LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations.