Facility Evaluation Report

Licensing Program Analysts (LPA) Ruth Wallace arrived at this facility to conduct an unannounced Required 1 Year Annual Inspection Visit. LPA Wallace introduced herself to house manager and explained the purpose of the visit. Additionally, LPA was screened for COVID-19 symptoms with temperature prior to being allowed inside the facility. Administrator was not available during the time of visit.

LPA and house manager inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living room, and outside areas of the facility to ensure compliance with Title 22 regulations. LPA Wallace also conducted the infection control domain tool.

The facility has an approved LIC 808 mitigation plan on file. LPA Wallace went over the infection control domain and mitigation plan. The facility has one central entry point and has implemented screening and sign in procedures at the front of the home. LPA observed the facility to have hand washing signs posted throughout the facility. Staff informed LPA that they are allowing in-person visits. The facility has a designated infection control lead. The facility is able to designated and dedicated a COVID-19 bedroom and bathroom if needed. Water temperature reads 111.4*F in the kitchen sink , which is within regulatory range of 105 *F and 120 *F. Room temperature reads 74° F. LPA observed the facility to have adequate food supply with emergency food supply kit. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were current and last check on 10/18/2022. Medications cabinet was locked.

LPA reviewed three (3) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (2) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils.

LPA Wallace requested updated copies via email to LPA by August 15, LIC 308 - Designation of Administrator, LIC 610D Emergency Disaster Plan, and Copy of Surety Bond

Per California Code of Regulations, Title 22, No deficiencies were observed during this visit and can be found on LIC 809-D. Exit interview was held with staff while Administrator. A copy of the report was given to house manager and left at conclusion of visit.