Facility Evaluation Report

At 09:45 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. The LPA met with Administrator Rafael Silva and informed them of the reason for the visit.

Record Review: At 10:00 a.m., a review of facility files was initiated. The LPA observed documentation of Infection Control Plan, and Emergency and Disaster Plan. The LPA obtain copies of Client and Staff rosters, Surety Bond, and Insurance Liability. The LPA reviewed five (5) resident files for documents including but not limited to resident physician's report, needs and service appraisal, consent forms, and personal rights. The LPA observed that all 5 residents needs and service plans were not signed by the resident and/or their responsible party. The LPA reviewed five (5) staff files for documents including, but not limited to: health screening, TB test, staff training records, and fingerprint clearance. The LPA observed that two staff (S1-2) did not have their annual training on file. Otherwise all other documents were complete and current.

Medication Audit: Medications audit was initiated during today's visit. The LPA observed medications for one (1) resident. All medications were stored properly in a med cart inaccessible to residents in care and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review.

Due to time constraints the LPA will return at a later date to complete the annual. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator.