Facility Evaluation Report

Licensing Program Analyst (LPA) Avelina Martinez and Arielle Pascua made an unannounced visit to this facility to conduct an annual inspection on 06/29/2022 at 10:00 AM. LPAs met with Madeline Amor and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate and expires on 11/16/2022. The facility is licensed for six non-ambulatory. There are currently 4 residents who reside at this facility.

LPAs toured the facility with Madeline Amor on 06/29/2021 at 10:30 AM.

The facility has a main entrance screening point, however, the facility does not have Covid-19 Precautionary visitor sign in log/book. The facility has Covid-19 posting throughout the facility. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily.

The facility has an adequate supply of food. The facility has an adequate supply of plates and utensils. The facility water temprature measured at 110 degrees. The facility temperature was 77 degrees. During the visit, LPA Martinez smelled gas, and informed care staff Madeline Amor. Stove knob was not turned off. Madeline Amor was advised to open door for ventilation. LPA Martinez requested fire drill documentation. LPA Martinez and LPA Pascua inspected exit emergency exit gate, and it was locked and could not be open. Second exterior gate is not in good repair and has overgrown grass covering part of the door. Carbon and Smoke detectors are in good repair. Fire extinguisher is in good repair. First aid kit was complete. The facility medications and toxins are inaccessible to clients and secured in a lock cabinet.