Facility Evaluation Report

Licensing Program Analyst (LPA) Arielle Pascua and Licensing Program Manager (LPM) Stephenie Doub, arrived at the facility on 07/05/2022 at 12:30pm to conduct an unannounced annual visit. LPA observed a sign for an active COVID case on the facility front door. LPA rang the doorbell and a caregiver answered the door and confirmed that there is an active COVID case at the time. LPA Pascua will return at another time to complete the annual visit.

Licensing Program Analysts (LPAs) Charlie Yang and Arielle Pascua conducted an unannounced Required-1 Year visit on 07/25/2022. LPAs met with the Facility Designated Administrator, Saul Kanno and stated the purpose of today's visit. 2 staff members were present. Census was 6 residents.

Fire extinguishers appeared to have been annually inspected on 02/04/2022.

A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet resident needs at this time.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.

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

The kitchen area was toured. LPAs observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator in the back patio.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.