Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and was granted access into the facility by Suzette Hojilla, Caregiver. Administrator Lovelyn Hojilla arrived later.

LPA toured the facility, all exits were unobstructed. The facility was found to be at a comfortable temperature. LPA observed a supply of linens (bedding, towels, etc.), and cleaning solutions (observed locked & inaccessible). Resident bedrooms were furnished per regulation. Facility food supply was within regulation and accessible to clients. Medication was centrally stored. Water temperature was tested and observed between 105 to 120 degrees F.

Disaster Drills are conducted quarterly as required. Fire extinguisher was charged and serviced 04/07/2023. There are 8 smoke detectors & 1 carbon monoxide detector, which were tested & observed operational. LPA reviewed staff and resident records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file.

LPA addressed fire clearance and postural supports deficiencies on continued page (LIC809-C). LPA discussed regulations 87465(h)(5) , 87463(c) , 87463(a) ; and discussed Health & Safety Code 1569.696(a)(1) & 1569.625(b)(2)

LPA requested the following updated forms to be submitted to Community Care Licensing by 07/06/2023:

· 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 Report continued on LIC809-C