Facility Evaluation Report

At approximately 9:15 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Licensee Alicia Poquiz was contacted and arrived at approximately 10:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with zero (0) Hospice residents currently in care, and is approved for four (4) non-ambulatory residents.

At approximately 9:50 AM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were observed charged and last inspected 6/24. Licensee stated fire inspection will be occurring 7/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 105.4 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 locked shed in the backyard which was inspected and observed to be a staff room. Facility has an internet access devise and internet available to clients in care, and the phone was tested and operational during today's inspection.