Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and met with Ana Morales-Astroga, 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 PPE, emergency supplies, linens (bedding, towels, etc.), and cleaning solutions (observed locked). Liquid hand soap and paper towels are available in 2 of 2 bathrooms. Client's bedrooms were fully furnished per regulation. Medication was centrally stored. Water temperature was tested and observed between 105 to 120 degrees F as required.

Quarterly Disaster Drills are conducted as required. Fire extinguisher were charged and serviced 11/23/2022. There are 10 hardwired combination smoke & carbon monoxide detectors which were tested and observed operational. LPA reviewed staff and client records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file. Client files are complete and up-to-date.

LPA requested the following updated forms to be submitted to Community Care Licensing by 07/30/2023:

· 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