Facility Evaluation Report

At approximately 9:45 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Licensee Paulino Buna arrived shortly after. Administrator Maria Buna arrived at end of inspection to sign report. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2) and hospice exceptions for two (2), with four (4) Hospice residents currently in care, and is approved for all non-ambulatory residents.

At approximately 10:00 AM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 9/25. Smoke and Carbon Monoxide detectors were tested and found operational by third party on 9/25. Water temperature measured which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked.

LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities.