Senior Care Records.

Facility Evaluation Report

Manor at Ashley, the, Antioch05/13/2022Licence 079200862

Capacity6
Census1
Date signed05/13/2022 10:54:08 AM
The inspector’s account

On 5/13//2022 at 9:25AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Josephine Tumbaga, Caregiver, and explained the purpose of the visit.. Josephine Limbo, Administrator, arrived at 10:35AM.

Upon entry, LPA's temperature was not checked. LPA observed screening station that contained hand sanitizer and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap, paper towel, and hand washing poster. Hot water temperature in the shared clients’ bathroom was measured at 112.8 degrees Fahrenheit. Fire extinguisher was last serviced on 11/20/2021.

During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed food and paper supplies are sufficient.

The following forms are to be updated and submitted to CCLD by 5/20/2022 :

-LIC308 Designation of Administrative Responsibility

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