Facility Evaluation Report

On 04/29/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Facility House Manager, Kenroy Anderson and explained the purpose of the visit. LPA asked that FHM Anderson call the Facility Designated Administrator (FDA), Norma Borges to inform them that CCL was present. There was one other staff member present, Nicolette Taylor. Shortly after, LPA met with FDA Borges. This purpose of this visit was to conduct an annual visit.

Current Census was 3. 1 out 3 residents were out at their respective day program.

A brief interview with FDA Borges was conducted.

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

LPA reviewed 5 staff files and 3 resident files. It was observed that 4 out 5 staff files did not have a complete personnel report. 3 out 5 staff members did not have TB tests that were conducted within 1 year prior or 7 days after of their hire date. It was also observed that 1 out 5 staff members did not have background association to the facility. The facility administrator has a current administrator certificate #6066265735 and expires on 06/01/2025.

A tour of the facility was conducted. It was observed that 2 residents were sleeping in their respective rooms.

PA observed a locked centralized stored medication cabinet located in the living room. It was learned that this facility now uses an Electronic Medication Administration Record. 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.

Fire extinguisher located in the living room was serviced by Jorgensen Co on 06/09/2023. Smoke Detectors and carbon monoxide was observed to be functional and in good repair. The last fire drill was conducted on 04/24/2024.

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.