The facility is licensed to operate for six (6) nonambulatory residents and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff room, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage.

LPA Kim toured inside and outside of the physical plant with AD Aguila and CG Gualta. There were no bodies of water or obstructions in the facility. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 106.5 degrees F to 107.6 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility.

LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, 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. Emergency food is stored in the kitchen, emergency water, and emergency supplies are stored in the garage. The facility has three (3) fire extinguishers that are charged and mounted in the kitchen, next to the staff bathroom, and in the laundry room, and all extinguishers were last inspected on July 22, 2024.

Evaluation Report Continues on LIC 809-C

LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S3), and medication administration record. LPA Kim conducted one (1) resident interviews and two (2) staff interviews.

A technical violation was issued at the time of the visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Imelda Aguila.