Facility Evaluation Report

At approximately 12:00 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Administrator Alicia Poquiz. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Hospice waiver for three (3), with one (1) Hospice resident currently in care, and is approved for four (4) 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 1:15 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and purchased 12/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures measured 116.2- and 117.1 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) locked shed in the backyard which contained paint and other supplies. Facility has an internet access device and internet available to residents in care, and an updated facility phone number was gathered during this visit.