Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted Required 1 Year Annual Inspection Visit. LPA Wallace introduced herself to Administrator and explained the purpose of the visit. Additionally, LPA Wallace was screened for COVID-19 symptoms with temperature prior to being allowed inside the facility.

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

The facility has an approved LIC 808 mitigation plan on file. 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, COVID-19 informational signage, and recent CDSS PIN's posted at the front door and throughout the facility. The facility is able to designated and dedicated a COVID -19 bedroom and bathroom if needed.

Water temperature read 107.2.°F in kitchen sink which is within regulatory range of 105 *F and 120 *F. LPA observed the facility to have adequate food supply with an emergency food supply. 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 are current. Medication cabinet was locked.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Administrator. A copy of the report was given and left with Administrator.