Facility Evaluation Report

On 05/08/23, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced annual inspection to this facility. LPA identified herself upon arrival and stated the purpose of her visit. LPA met with designated facility administrator, Roselyn Escorido (Administrator's Certificate # 6008620735, expiration date 10/02/23) and interviewed her briefly. At the time, census was 5.

LPA toured the facility including but not limited to: the kitchen/dining area, living room, 4 resident bedrooms, 2 staff rooms, 2 bathrooms, laundry room as well as the exterior grounds.

The tour began in the kitchen. The LPA had the staff open all the drawers and cabinets. LPA observed a large 6 inch chef's knife in a drying rack on the counter and another sharp knife in an unlocked drawer. LPA explained that this posed an immediate threat to residents in care. Staff secured the items in a locked cabinet. The LPA inspected the refrigerator and pantry and found the food supply was adequate for 2-day perishable and 7-day nonperishable.

The LPA noted that the fire extinguisher was inspected on 05/02/23 by Nor Cal Fire Inc.

LPA then tested the hot water in the bathroom adjacent to the kitchen. It measured 113 degrees Fahrenheit, within the required range of 105-120 degrees. The bathroom had paper towels for residents to use and was otherwise in compliance.

The LPA found the laundry room unlocked and toxins on the floor. This posed an immediate threat to residents in care. Staff immediately locked the door and returned to compliance.

LPA observed 4 resident bedrooms and found them all to be in compliance with the required furniture, (Continued on LIC 809C.)