Facility Evaluation Report

On 11/30/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to conduct an annual visit. LPAs met with Licensee, Saudia Whitaker and explained the purpose of the visit. There was one other staff member present at the facility Richard Chea. Shortly after, LPAs met with Facility Designated Representative (FDR), Derek King.

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

LPAs reviewed 3 resident files and 3 staff files. The facility administrator has an active certificate #6048033735 and expires on 08/31/2024.

Current Census was 3. Tour of the facility was conducted. Smoke detector and carbon monoxide detectors were tested and observed to be in good repair at this time.

Fire extinguisher located by the dining room appeared to have been annually inspected on 04/19/2023.

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 living 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 perishable and non-perishable food supple was identified. 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.

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