Facility Evaluation Report

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. visit of the facility. LPA was welcomed by staff Joyce Torres. LPA met with Teddy Rico, Licensee. There is a total of 6 residents and 3 with a diagnostic of dementia. There is one resident currently on Hospice.

LPA toured the facility on 8/3/2023 at 10:50 AM with licensee, Teddy Rico; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices which were working properly at the time of the visit. Fire Extinguisher was found to be last charged on 1/23/2023 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 114.9 degrees F and 115.8 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 8/3/2023. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Sharps were stored in locked drawer in kitchen although some knives were also observed by LPA and licensee on 8/3/2023 at 11:01am in unlocked kitchen drawer (see LIC809-D). Toxins stored in a cabinet in the garage has broken lock (see LIC809-D) and exit door from kitchen to garage was turned off at the time of the visit on 8/3/2023 at 11:05 am (see LIC809-D). There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 8/3/2023 at 11:10 AM.