The facility is licensed to operate for five (6) nonambulatory residents 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: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, studio, and an attached two car garage.

LPA Kim toured inside and outside of the physical plant with LI Asis. There were 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 119.1 degrees F to 119.8 degrees F. A comfortable temperature of 71 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, 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 was stored in the closet across from Resident Room #1 and emergency water and emergency supplies were stored in the garage. The facility has two (2) fire extinguisher that were charged, and mounted in the kitchen and next to the garage door.

Evaluation Report Continues on LIC 809-C

LPA Kim conducted an audit of resident files (R1-R3), staff files (S1-S8), and medication and medication administration review that were in order and complete. LPA Kim conducted two (2) staff interview.

A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations.

An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Emelyn Asis.