Senior Care Records.

Facility Evaluation Report

TLC Adult Home, Pine Grove02/23/2023Licence 037003702

Capacity3
Census1
Date signed02/23/2023 10:25:06 AM
The inspector’s account

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual inspection. LPA met with Administrator Carolyn Meeks, and explained the purpose of the visit.

LPA completed the infection control tool. LPA and Administrator toured the facility to ensure compliance with Title 22 regulations. LPA observed the resident bedroom. The bedroom were observed to have necessary furniture and furnishings. The rooms were organized and free from debris. The bathrooms were observed to be clean and free from debris. The hot water measured at 106.2*F, which is within the regulatory range. The facility is equipped with an emergency supply of food and water, a supply of perishable foods for seven days, and a supply of non-perishable food for a minimum of two days. The facility is equipped with an all house generator should the power go out. Fire extinguishers were observed to be in working condition and up to date. Medications, sharps, and cleaning supplies were observed to be locked away and inaccessible to residents in care.

LPA requested the following documentation be sent to the Regional Office: LIC 500 Personnel Summary, LIC 308, LIC 610, Surety Bond

No deficiencies were observed during today's visit. An exit interview was held with Administrator Carolyn, and a copy of the report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction