Facility Evaluation Report, 07/12/2023 — Empire Guest Home, Empire CA

Unannounced annual visit made out to this facility on 07/12/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Joan Little and Mark Little. Brief interview was conducted with the facility designated Administrator Joan Little and co-Licensee Mark Little at this time.

It was learned that this facility was licensed for a total of 23 residents, of which, (7) were allowed to be non-ambulatory.

This facility was also vendorized through Valley Mountain Regional Center as well.

Current census was 21 residents, of which, (2) residents were present at this time while the other residents were out of this facility at their respectable day programs. It was also learned that (6) residents were away at a summer camp for the week as well.

Kitchen area was toured. Cabinets and drawers were reviewed for an adequate supply of plates, silverware, and other items intended for use by the residents. Cleaning agents and detergents were stored and maintained under the sink cabinet which was observed to be locked and made inaccessible to the residents at this time.

Knife drawer was observed to be locked and made inaccessible to the residents at this time.

Food supply was reviewed for an adequate supply of 2-day perishable and 7-day nonperishable food quantities at all times. LPAs observed several food storage units within this facility in the form of additional refrigerator and freezer units.

Medication room was toured. LPAs observed the use of a medication cabinet that was locked and made inaccessible to the residents at all times.

This facility employed the use of an paper MAR system to dispense, manage, and document all medications for the residents at this time.

First aid kit was observed to be present and contained all of the required components at this time.

Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 12/12/2022 by the local fire extinguisher company, USA Stanislaus Company, and in compliance at this time.