Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and met with Alma Corsiga, Administrator .

LPA toured the facility, all exits were unobstructed. The facility was found to be clean & at a comfortable temperature. LPA observed a supply of linens (bedding, towels, etc.) and cleaning solutions (observed locked & inaccessible). Hand soup and paper towels are available in bathrooms. Facility food supply was within regulation and accessible to residents. Medication was centrally stored; Administrator understands regulation 87465(h)(5) that medication shall be stored in its original container and pre-pouring medication (even up to 24 hours ) is not allowed. Water temperature was tested and observed between 105 to 120 degrees F.

Fire extinguisher was charged and serviced 05/12/2023. Smoke detectors & carbon monoxide detector observed operational. LPA reviewed staff and resident records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file. LPA discussed regulation 87608(5)(A) for half rail use and 87202(a)(1)(2). LPA advised Administrator to submit a fire clearance request for 1 bedridden room for future residents. Administrator to submit LIC200 requesting 1 bedridden & 5 non-ambulatory, and include updated facility sketch (including activity room in backyard) labeling bedridden and non-amb rooms. LPA discussed regulation 87305(a) regarding activity room built in backyard needing a permit.

LPA requested the following updated forms to be submitted to Community Care Licensing by 08/11/2023:

· LIC 308 Designation of Facility Responsibility (1 person per form)

· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents)

· LIC 9020 Facility Register of Client/Residents

· Copy of current Administrator's Certificate

Exit interview conducted with Administrator, whose signature on this document confirms receipt. ***No deficiencies cited during this inspection