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) Tao conducted an unannounced annual inspection visit. LPA met with Gladys Pervez, administrator who assisted with the visit. The facility is licensed to serve one (1) bedridden and five (5) non-ambulatory residents (ages 60 and above). The facility has an approved five (5) Hospice Waivers. Currently, there are five (5) residents in placement including three (3) hospice residents. Annual licensing fees are current. Administrator certificate is current and the expiration date is 02/08/25.
During the visit, the CARE tool was used, facility was toured, staff/residents were interviewed, staff/residents records were reviewed, food supply was reviewed, and medications were reviewed.
The facility is located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. LPA observed the facility to have four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, garage equipped with a laundry area and an indoor/outdoor activity area. No pools and bodies of water on the premises. All residents' bedrooms and bathrooms had appropriate furnishing and in compliance. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 118.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Auditory alarm devices to monitor exits were operable. Last fire drill was conducted on 08/08/23. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is on 6/6/23 and are fully charged.
Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication is centrally stored in a locked cabinet; resident records are stored in a locked room and both inaccessible to residents. Toxic substances are inaccessible to residents. Outdoor facility space for residents' leisure are completely enclosed by a fence with self-closing gates. No deficiencies were observed and cited per California Code of Regulations, Title 22.
An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez's signature on this form confirmed receipt of these documents. A copy of LIC 809 report was provided. |