Facility Evaluation Report

Licensing Program Analyst(LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection and met with caregiver Marife Davis. There were two other caregivers at the facility, Robert White, and Estelita Cabardo. Robert contacted Administrator Eden Relota, and notified them the LPA was at the facility. The Administrator arrived to meet with the LPA.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. Per file review, last fire drill was completed on 12/5/23. Licensee is completing fire/evacuation/emergency drills quarterly as required.

Fire clearance is approved for four (4) non-ambulatory, of which one(1) may be bedridden. There were four (4) residents in care at the facility; One (1) resident currently on hospice care.

LPA reviewed four (4) resident files. All files were complete.

LPA reviewed four (4) staff files. All staff have criminal record clearance as required. All staff have annual training. All staff have required First Aid & CPR certification.

LPA toured the facility with the Administrator. All exits were unobstructed. Fire extinguisher was serviced and tagged as required- expires 5/9/24. Carbon monoxide detector was working properly during the inspection. All smoke alarms were working when checked during the inspection. All bathroom(s) had grab bars, and non-slip mat/flooring for bathing as needed.

All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Sufficient food supply, perishables and non-perishables.