Facility Evaluation Report

Licensing Program Analysts (LPAs) Alviso and Contreras arrived unannounced to conduct a Required -1 Year inspection, on 2/19/25 at approximately 12:20pm, and met with caregivers Ann and Fredah. Staff contacted Administrator Monicah Gacegu and notified them the LPAs were at the facility. The Administrator arrived to meet with the LPAs.

Fire clearance is approved for eight (8) non-ambulatory only. There were seven (7) residents in care at the facility during the inspection. `

Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan.

LPAs reviewed seven (7) resident files, including storage of medications and medication records.

LPAs reviewed three (3) staff files, including training. All staff have required criminal record clearance.

LPAs toured the facility with the caregiver Fredah; LPAs toured the facility with the Administrator when they arrived. LPAs observed cleaners/disinfectants locked and inaccessible to residents in care. All medications were locked and inaccessible to residents in care. All exits were free and clear of obstructions. There was a sufficient supply of perishable and non-perishable food. There was a sufficient supply of hygiene products, linens, paper products, and personal protective equipment (PPE) for use as needed. Carbon monoxide detector was working properly during the inspection. All resident rooms and common areas had required smoke alarms. Fire extinguishers was serviced and tagged as required. There was sufficient lighting in the resident rooms, bathrooms, and all common areas.

LPA is requesting the following documents be updated and submitted by 3/19/25:

LIC308 - Designation of Administrator Responsibility

LIC610E-Emergency Disaster Plan- review and if no changes, submit a copy of last page w/signature & Date. If changes, submit a copy of the plan.