Facility Evaluation Report

Licensing Program Analyst(LPA) Alviso conducted Required -1 Year inspection, on 1/24/24 at approximately 2:45pm, and met with Administrator Jose Acumabig. Currently there are twenty-one (21) residents in care.

The facility has a required infection control plan . LPA toured the assisted living area, first (1st) and second (2nd) floors. All resident units have been renovated, but two. These two units are now vacant, and will be renovated before being occupied. All bathrooms observed by the LPA, had grab bars as required/needed for resident use. All fire extinguishers were serviced and tagged.

Facility has applied for an increase in capacity; Facility requested to go from forty-five residents, to a total of seventy-five residents. Facility fire clearance is approved for seventy-five (75) non-ambulatory residents- effective 1/19/24; Fire cleared resident rooms/units are 157-187 on the first floor, and 257-287 on the second floor. The facility will now be licensed for seventy-five (75) non-ambulatory residents; The increase in capacity is approved, effective 1/24/24.

LPA is requesting the following documents be updated and submitted by 2/24/24

LIC308 - Designation of Administrator Responsibility

LIC610E-Emergency Disaster Plan -Update if changes, submit copy and/or a letter/ last page of annual review completed

Infection Control Plan- Update if changes, submit copy and/or a letter/ last page of annual review completed

Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash.

Copy of current Administrator Certificate

The annual inspection will be completed by the Department at a later date.

Exit interview conducted with Administrator Jose Acumabig.