1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA explained the purpose of the visit and was granted entry by care staff. Licensee, Angelica Kutnerian (AD1) and Teresa Long (AD2) arrived few minutes at the facility to complete this annual visit.
The residence was set at 73 degrees F temperature and free of passageway obstructions inside and outside. LPA observed six bedrooms in the residence. All six bedrooms are occupied and were inspected. All bedrooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 111.0 degrees F.
Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies were locked and stored in the laundry room. Smoke detectors and carbon monoxide are dual detectors, they were checked and operating. Fire extinguisher was charged and was serviced on 8/02/23. Emergency disaster drills are conducted quarterly, last drill completed on 12/01/23. First Aid kit is fully equipped.
There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.
An exit interview was conducted, and a copy of this report was provided to AD1 whose signature confirms receipt.
LPA requested the following updated forms faxed to CCLD by 1/18/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage. |