Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year inspection at the facility today. The LPA met with House Manager Allan Santos and explained the reason for the visit. The LPA later met with Administrator Ivy Sudjati and explained the reason for the visit.

RECORDS: .A review of facility files was initiated. Facility records are stored in the locked cabinets and drawers. The LPA observed documentation of Infection Control Plan, Emergency Disaster Plan and last Disaster drill (conducted on 10/07/2025). The LPA obtained Client Roster, and Staff Roster. The LPA reviewed five (5) out of five (5) resident files. Resident files reviewed were found to be complete. The LPA reviewed five (5) staff files. The following was observed: Two (2) staff (S1, S2) were missing one hour of restricted health conditions, hospice and postural support training.

MEDICATIONS: LPA reviewed medications for two (2) residents. The LPA observed the following: medications are centrally stored and locked in a locked cabinet in the laundry room area; medications are labeled and checked for expiration dates. Medications are documented on the centrally stored medications and destruction record (CSMDR). However, during both resident's audit, the LPA observed eight or more medications without the strength documented on the CSMDR and each resident did not have one of their medications documented on the CSMDR.

The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Report will continue on LIC809-C, 2ND PAGE.