Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a required- 1 year inspection, on 1/21/25 at approximately 12:30pm, and met with Administrator Teresita Shevick. LPA observed a caregiver on duty during the inspection, Cindy Magnuson.

Facility is fire cleared for six (6) non-ambulatory residents, of which one (1) may be bedridden. Facility has an approved dementia plan of operation. Hospice waiver approval is for three (3) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. Per file review. last emergency drills were held on 12/12/24, Earthquake drill, and on

LPA reviewed five (5) resident files; All records were complete.

LPA reviewed four (4) staff files, including training. All staff had required criminal record clearance. All staff had required first aid certification. S4, caregiver had both first aid and CPR certification.

LPA toured the facility with the Administrator. Hot water was checked at 117.1 degrees Fahrenheit, which is within regulation. The facility was observed to be at a comfortable temperature. The food supply was sufficient in perishable and non-perishable items. All exits had working auditory alarms, all exits were clear and unobstructed. There was a sufficient supply of paper products, cleaners/disinfectants, personal protective equipment (PPE), and hygiene products. There was sufficient lighting in all common areas, resident rooms, hallways, and bathrooms. Sufficient furnishings throughout the facility for resident use. Fire extinguisher was serviced and tagged as required.

LPA discussed fire clearance and regulation requirements with the Administrator regarding the backyard walkways and fire exit path are to remain clear and unobstructed at all times; Administrator stated to the LPA their understanding of the above information discussed.