Facility Evaluation Report

On 10/24/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Amy Cook and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, garage, backyard, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids. Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured at 108 F. LPA observed one (1) fire extinguishers, fire detectors, and carbon monoxide detectors.

LPA reviewed a total of four (4) residents' files and three (3) staff files. Two of the three staff files have missing TB testing. One staff file had missing criminal clearance.

California Code of Regulations,(Title 22), is being cited on the attached LIC809D. A civil penalty for $100 per day for a maximum of 5 days, totaling $500 for criminal record clearance violation is being assessed on the attached LIC 421BG.

An exit interview was conducted, and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report, LIC 809-D, LIC421BG, and Appeal Rights were discussed and provided to Administrator.