Facility Evaluation Report

On 08/4/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Licensee Marietta Diaz.

Tour was conducted with Licensee Marietta Diaz and Avelina Sanlitan, designated representative. All pathways, entrances and exits were clear from obstructions. LPA and staff began the tour at the facility kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. At 10:38 AM LPA observed Fire extinguisher in the Kitchen to be expired with a service date of 7/27/2022. Tour continued to laundry room which has locked chemicals and cleaning supplies. At 11:09 AM LPA observed the facility front load washer to have what appeared like possible mold or mildew on the washer’s front plastic plate. LPA observed a staff room, storage area and staff bathroom.

Tour continued to the living room which has sufficient seating and office area. LPA toured two more staff rooms with bathroom in hallway. Medications, PPE supplies, and files are locked in hallway closet. LPA toured two shared resident bedrooms which were observed to be furnished with required furniture and adequate lighting. Bedroom share a bathroom. Linen and hygiene supply is kept in the hallway closet. Carbon monoxide and smoke alarm detectors installed and operational. LPA reviewed resident’s medication and Centrally Stored List for all residents. At 12:46 PM LPA observed residents’ files to be missing Needs and services plan. LPA reviewed Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health, First Aid training. LPA observed sufficient seating under covered patio area in the back of the facility. Backyard gate was self-latching and self-closing.

Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22,