Facility Evaluation Report

On 11/3/2022 starting at 9:00 a.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct a post-Licensing Inspection after facility accepted the 1st resident in October 2022. LPA met with Administrator and staff and disclosed the purpose of the visit. Administrator was not available and authorized staff to sign on the report.

During the inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, kitchen, common areas, and backyard. There is one central entry point for universal screening for staff, residents and visitors. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has Infection Control Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff and visitors.

THE FOLLOWING DEFICIENCIES WERE OBSERVED:

· Approximately 9:20 a.m., LPA observed 10 knives and 1 scissor in the kitchen drawer without being locked. Staff locked them up during visit.

· Approximately 9:30 a.m., LPA observed water temperature was 137.2 degree F.

· Approximately 9:40 a.m., LPA observed the fire extinguisher was last purchased on 8/1/2021.

· Approximately 9:45 a.m., LPA observed gardening tool, paint, and gardening chemical supplies located in the backyard were observed unlocked. Staff locked all items during visit.

· Approximately 10:00 a.m., based on record review, LPA observed that there has no Physician's Report, Pre-Admission Appraisal, and Admission Agreement on resident's file.

The above deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted with staff. LIC809D, Appeal Rights and a copy of this report provided.