Facility Evaluation Report

On 04/05/2023 at 11:00am, Licensing Program Manager (LPM) Emerita Curiel and Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPM Curiel and LPA Pascua were greeted by Facility Designated Administrator, Julian Hawes and explained the purpose of the visit. There were three other staff members present during the course of this visit Iboni James, Alma Moyamoy, and Jada Hull. Current Census was 4. 1 out of 4 resident were out at their respective day programs at this time.

This facility is licensed to serve 4 residents at this time. This facility is also vendorized by Valey Mountain Regional Center to served and accept Level 4I residents.

LPA and LPM review 5 staff files. All staff files were current and up to date. LPA and LPM reviewed 4 resident files. A resident files were current and up to date. No residents were interviewed at this time due to medical conditions or due to the resident sleeping. The administrator has a current and active Administrator certificate #6052806735 and expires on 07/29/2023.

LPA observed a locked centralized stored medication cabinet located in the living room. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour with FDA Hawes was conducted. Fire extinguisher located in the living room was serviced by Jorgensen Co on 06/15/2022.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care.