Facility Evaluation Report

On 03/14/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by staff member (SM), Edmund Luzon and explained the purpose of the visit. It was asked at this time to go ahead and call the Facility Designated Administrator (FDA), Marisa Tojino, to inform her that CCL was present. There was one other staff member present, Tiffany Rendon. Shortly after, FDA Marisa Tojino arrived at the facility. This facility is currently licensed to hold 6 residents and is vendorized by Valley Mountain Regional Center to hold and accept Level 4 residents at this time. A brief interview was conducted with FDA Tojino.

Current census was 5. A brief interview with FDA Tojino was conducted.

LPA reviewed 6 staff files. 6 out of 6 staff files are up to date. LPA reviewed 3 resident files. 3 out 3 resident files were current and up to date. The Facility Designated Administrator (FDA) has a current administrator certificate #6023095735 and expires on 12/28/2024.

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 Tojino was conducted. Fire extinguisher located in the hallway was serviced by Assured Fire Service Company on 08/17/2023.

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.