Facility Evaluation Report
On 09/22/2021 at 12:30pm, Licensing Program Analysts (LPAs) L. Francisco and L. Hall arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPAs met with Care Staff, Gwen Green. Administrator/Licensee, Ericka Tillis later arrived at 1:00pm.
During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and outdoor area. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff.
The following deficiencies were observed:
-At 12:55pm, LPAs observed 9 residents at the facility.
-At 2:00pm during record review of R1's physician's report, LPAs observed R1 is non-ambulatory
The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies by POC date may result in additional Civil Penalties.
An immediate $1,000 civil penalty is being assessed.
Exit interview conducted. Appeal Rights and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction