Facility Evaluation Report
On this day, April 14, 2023, at 10:10 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Sunita Suman, and informed the reason for visit. LPA spoke with Benjamin Blake, administrator, over the phone who stated he can not come to the facility at the moment and authorized Sunita Suman to be with LPA during inspection. Administrator arrived at around 11:40 am.
The facility is a two story building. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, shower rooms, kitchen, computer room, art room, dining area. LPA also inspected the spare office/break-meeting room on the second floor. Facility has sufficient perishable and non-perishable foods. Fire extinguishers were observed fully charge with tags showed serviced January 6, 2023. Facility has 2 in 1 carbon monoxide and smoke detectors that were tested and observed functional. Hot water temperature in one of the common bathrooms was tested and measured at 109.5 degrees Fahrenheit. Facility has LIC808 Mitigation Plan but has not submitted the Infection Control Plan
LPA reviewed 5 residents and 5 staff files, and interviewed 3 residents and 3 staff. Medications were checked and compared against records. Facility does not handle residents' cash resources.
LPA obtained copy of LIC610D Emergency Disaster Plan on this day.
Administrator to submit updated copies of the following documents by April 28, 2023:
1. LIC308 Designation of Facility Responsibility
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction