Facility Evaluation Report

At approximately 11:40 AM Licensing Program Analyst (LPA) Star Stevenson arrived to CONTINUE a required 1 year annual inspection and was greeted by caregiver Florencia Rivera who called Licensee/Administrator Pritpal Atwal who arrived at approximately 12:15 PM.

Facility continues to care for six (6) residents, three (3) of which are on hospice.

Facility conducts regular quarterly disaster drills, and the most recent drill was conducted May 2025. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA reviewed facility's emergency disaster plan last updated 07/2024.

At approximately 12:30 PM, three (3) staff files and five (5) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial and annual training hours. LPA reviewed five (5) of six (6) resident files which contained all required documentation including negative TB and/or negative chest X-ray for active disease. Licensee/Administrator states residents' families coordinate their medical and dental appointments as needed and provide their own transportation to and from these visits. LPA reviewed medications which were observed to be locked and medication records were observed to be maintained in compliance with regulation. Facility does not maintain P&I monies for residents and Community Care Licensing Department (CCLD) has a signed Affidavit (LIC400) on file.

LPA requested the following updated forms to be submitted to Community Care Licensing by 08/11/2025:

-Any NEW LIC 308 Designation of Facility Responsibility (1 person per form)

- Copy of current valid and non-expired Liability Insurance

- LIC 9020 Facility Register of Client/Residents

- LIC 610E Emergency Disaster Plan (updated)

No Deficiencies are cited today. Exit interview conducted with Licensee whose signature on this document confirms receipt .