Facility Evaluation Report

At approximately 10:30AM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Administrator Delia Ulbata. Facility is a Residential Care Facility for the Elderly (RCFE) with ten (10) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 10:40AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. LPA was informed that the second story is solely for live in-staff and is only accessible from a locked outside door. Facility's fire extinguisher was observed charged and LPA was informed it was newly purchased. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 111.3 degrees F, 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. LPA observed one (1) unlocked shed in the backyard which LPA inspected and observed to contain old mobility devices