Facility Evaluation Report

At approximately 1:35 pm, Licensing Program Analyst (LPA) Stevenson arrived unannounced to BEGIN a required 1-year annual inspection and was greeted by Rose Marie Vister, Designated Responsible Party (DRP). Administrator Maria Salvador was contacted via telephone and advised of the inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for all non-ambulatory residents with approval for one (1) bedridden resident.

At approximately 01:45 PM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA continues to see evidence of on-going rodent treatment with various traps below kitchen sink and garage used as additional pantry with foods in storage devices. LPA observed large hole in the exterior wall behind garage wash machine and dryer that represent and easier access point for rodent into the garage being used as a pantry/storage. LPA observed worn carpeting with staining throughout the facility as seen in the last annual inspection performed. A drawer face to the left of the stove was loose and evidence of water intrusion into the sheet rock in the bathroom walls was evident. In addition, LPA observed two (2) rotten deck boards outside the living room sliding door that represent a tripping hazard. 4 of 8 smoke detectors either required new batteries or did not emit the proper volume of alarm and a Plan of Correction (POC) was made to address a number of the facility issues. A repeat citation 87303(a) for grounds out of repair and civil penalty is being assessed. (See LIC809-D page)

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, incontinent care, and paper products available for residents. Cabinets containing cleaning supplies and medicines and other items that could pose a risk were locked.