Facility Evaluation Report

On 08/10/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced facility to conduct an Annual Visit. LPA Pascua was greeted by Licensee representative, Sean Alicante and explained the purpose of the visit. Shortly after, LPA Pascua met with Facility Designated Administrator, Quincy Beltran.

This facility is licensed to served and accept up to 6 residents who are deemed to be non-ambulatory only. This facility is also vendorized to accept and retain Level 4F residents at this time.

Census was currently at 4. 4 out of 4 residents were out at their respective day program. A brief interview with, Licensee Alicante was conducted.

LPA reviewed 4 resident files. 4 out 4 resident files were complete and up to date. LPA reviewed 4 staff files. 4 out of 4 staff files were complete and up to date. Tour of the facility was conducted.

Fire extinguisher located by the dining room appeared to have been annually inspected by the Cal-State Fire on 04/20/2023.

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. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Additional non-perishable food supply was identified in the pantry.

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

A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. Additional incontinence supplies were also identified.

A tour of the laundry room was conducted. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.