Facility Evaluation Report

At approximately 9:35 AM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required Annual Inspection and required quarterly NCC visit. LPA was met by caregivers Martha Reyes and Lorna Valasquez. There are 6 residents in care with 2 on hospice.

At approximately 10:00 AM a tour was conducted and facility was found to be clean and well organized, and a comfortable temperature. Residents were clean and dressed appropriately. There was an ample supply of hygiene products for residents' care. There was also an ample supply of healthy perishable and non-perishable food as required by Title 22. Water temperature in 2 of 2 bathrooms measured 117.1F and 118.4FF and within regulation of 105 -120 F. There was one fire extinguisher that was last serviced on 2/16/2024 and observed to be fully charged. Smoke detectors/carbon monoxide detectors are centrally wired and tested to be functional. The front and back yards are well-maintained and the back yard pool is fenced and secured as required by regulation. There is also a covered patio with seating for outdoor activities and visits. There are comfortable couches and chairs in the living room with television and simple games available. Soaps and toxins, as well as sharps were locked securely and inaccessible to residents. Medications were kept secured in a closet in hallway.

The last fire drill was held on 2/16/2025 by verbal report. Caregivers were told of the requirement to conduct and document quarterly emergency drills. (Technical Violation issued)

At approximately 11:00 AM five (5) staff files were evaluated and 3 of 5 were found complete and 2 of 5 files observed that S1 needs evidence of MD assessment and TB clearance and S2 needs evidence of 1st Aid Training (technical violation issued) Designated caregiver was asked to ensure that personel files be completed with records TB clearance and 1st aid training. (technical violation issued)

Five (5) of six (6) Resident files were reviewed and 5 of 5 were found to have all required documentation including signed POLST forms by their responsible parties, but were missing Consent for Emergency Medical Treatment forms (LIC627C) (Technical Violation issued)