Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required 1 Year inspection at the facility today. The LPA met with staff and explained the reason for the inspection. When the LPA arrived there were two staff and six residents present. Administrator Arlene Martinez arrived shortly after. The administrator had to leave at approximately 2PM and designated Carestaff Grace Natividad to review and sign the report.

RECORDS: The LPA initiated a record review. Facility records are stored in a locked medication closet. The LPA observed documentation of Infection Control, Disaster prevention, Emergency and Disaster Plan and last Disaster drill (conducted in 07/2025). The LPA obtained Client Roster, and Staff Roster . The LPA reviewed five (5) out of six (6) resident files and five (5) out of eight (8) staff files. The following was observed: Two (2) residents did not have the Consent for Emergency Medical Treatment form LIC627C on file, one (1) resident did not have an annually updated appraisal/needs and service plan on file, and two (2) residents did not have signed personal rights forms on file. Additionally, two staff did not have a criminal record statement on file and one (1) staff did not have any documentation of medication training.

MEDICATIONS: Medications are locked and centrally stored in a closet in the hall. LPA reviewed medications which appear to be given as prescribed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record.

At 2:10 p.m. the LPA toured the physical plant areas inside and outside, with staff 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.