Facility Evaluation Report

On 03/22/2023 at 10:00am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPA was greeted by staff member (SM), Mary Gonzalez and explained the purpose of the visit. It was at this time where LPA asked SM Gonzalez to call and inform the Facility Designated Administrator (FDA) that CCL is present at this time. Shortly after, LPA met with FDA, Quincy Beltran. There were 2 other staff members at present during the course of this visit, Anabel Contreras and Melissa Daoud.

This facility is licensed to for 6 residents who may be non-ambulatory. This facility is also vendorized by Valley Mountain Regional Center to accept and serve Level 4I residents at this time.

LPA reviewed 6 resident files. 6 out 6 resident files were current and up to date. LPA reviewed 8 staff files. 8 out of 8 staff files were current and up to date. The Administrator has an active and current administrator certificate #604787735 and expires on 04/18/2024.

LPA observed a locked centralized stored medication cabinet located in the kitchen. 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 Beltran was conducted. Fire extinguisher located in the living room was serviced by Cal State Service Company on 1/12/2023.

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. 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.

A tour of the garage was conducted. Additional food supply was identified.

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