Facility Evaluation Report

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Yerba Buena Residential Care Home for the purpose of conducting a Case Management-Annual Continuation Inspection. LPA was greeted at the door by Caregiver, Noel Marayag and was granted access into the facility. Licensee arrived 15 minutes later.

During the Case Management-Annual Continuation, LPA reviewed 2 of 2 staff files and found those files to be appropriate during the Required 1 year inspection. LPA reviewed 6 of 6 resident records. However, LPA observed 1 out of 6 residents did not have a physician signature on an LIC 602 (See LIC 9102-Technical Advisory) . 6 of 6 Medication Orders were reviewed with the Licensee. LPA interviewed 2 of 2 staff members. LPA interviewed 4 of 6 residents. Remainder of residents were asleep during the inspection. LPA requested the following documents to be sent:

LIC 400- Affidavit regarding Client Cash Resources

No deficiencies were observed or cited during today's Case Management-Annual Continuation Inspection. Exit interview was conducted and a copy of this report was given to the facility Caregiver.