Facility Evaluation Report

At approximately 12:30 PM, Licensing Program Analysts (LPAs) Julie Florio and Ethel Contreras arrived unannounced for the purpose of conducting a quarterly Non-Compliance (NCC) visit and were greeted by Samuel Padama, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with 3 residents in care.

At approximately 12:50 PM, LPAs initiated a facility tour with Licensee and observed the following: facility was a comfortable temperature, passageways were free from obstructions, items which could pose a risk to residents in care were observed inaccessible and cabinets containing such items were locked. Medications were properly stored. LPAs inspected the structure in the garage which did not contain any personal items, clothing, or sleeping materials, indicating the room is being used strictly for its approved purpose of storage.

At approximately 1:45 PM, LPAs reviewed resident and staff files which had all the required documentation. However, S1's file was observed missing proof of required medication and annual training for last 12-months (see LIC809Ds).

The following deficiencies were observed and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation or the California Health and Safety Code. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Licensees and appeal of rights provided. Signature on form confirms receipt.