Facility Evaluation Report

Licensing Program Analysts (LPAs), Alviso and Loera, conducted a continued annual inspection, on 8/5/24 at approximately 2:40pm, and met with Administrator/Licensee Estelita Guzman. Annual was started on 8/1/24, see LIC809.

Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. The facility has an emergency disaster plan as required. Fire extinguishers were serviced and tagged as required.

LPAs reviewed six (6) resident files. LPAs reviewed four (4) staff files.

The following deficiencies were identified during file reviews:

Resident's (R2) medical assessment was not complete, many sections were left blank on many pages of the assessment. A note on a page of the LIC602 medical assessment referred the reader to see attached "problem list and medication list." These items were not observed attached to the medical assessment. Administrator couldn't provide the medical assessment documents to the LPAs for review.

This deficiency will be cited, 87458(a) Medical Assessment- Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment, see LIC809D.