The facility is licensed to operate for four (4) non-ambulatory and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: Three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living room, dining room, kitchen, and an outside covered patio area.

LPA Kim toured indoor and outdoor of the physical plant with Caregiver DeLos Angeles There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.7 and 110.1 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. A working telephone (714-990-5952) remains available. First Aid Kit contained all the necessary elements.

Evaluation Report Continues on LIC 809-C

LPA conducted an audit of all resident files (R1-R2), all staff files (S1-S2), and medication and centrally stored medical destruction record. LPA Kim conducted two (2) resident interviews and one (1) staff interviews.

Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report was provided to Caregiver Orlando DeLos Angeles.