Facility Evaluation Report

On 9/13/2021 at 9:40am, Licensing Program Analyst (LPA) A. O'Hollaren arrived unannounced to conduct Infection Control Inspection. LPA met with Staff S1 and explained the purpose of the visit. Licensee Shirley Bordon arrived at approximately 10:17am.

During the inspection, LPA toured facility including but not limited to common areas, hand washing stations, bedrooms, kitchen and backyard. LPA observed COVID-19 signage posted in common areas. Common bathroom was equipped with soap, paper towels and garbage. Hand washing posters was posted in common bathroom. LPA observed food, PPE and paper supplies are sufficient. Common areas are disinfected daily.

During record review, LPA observed facility has a copy of Mitigation Plan on file.

LPA observed antifreeze and coolant in unlocked shed.

The following deficiency was observed (See LIC 809D) and cited from the California Code of Regulations, Title 22 and California health and safety code. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted and a copy of this report and appeal rights provided.