Facility Evaluation Report

At 9:00 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year visit to the facility. Upon arrival the LPA met with Licensee Jocelyn Cacal. Entrance interview conducted and the reason for the visit was explained.

A tour of the physical plant was conducted with the Licensee between 9:18am - 9:30am to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single story residence that consists of two (2) resident bedrooms and one (1) bathroom. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. LPA observed all required postings in the living area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer in the kitchen.

Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

Bathrooms: The LPA observed the bathroom clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in the bathroom . Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured in the bathroom during the physical plant tour. Hot water measured 117.4 Fahrenheit, within the required limit of 105-120 degrees.

Common Areas : These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit.