Facility Evaluation Report

On 5/17/2022 starting at 11:04 a.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with House manager Monique Robinson and disclosed the purpose of the visit.

During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. There is one central entry point for universal screening for staff, residents and visitors. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has Mitigation Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff and visitors.

· Approximately 1:00 p.m., LPA observed there was no space for resident's belonging at bedroom 6, the closet was filled up with mattress, pillows, toys, and clothing were not related to resident.

The above deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties.

Exit interview conducted with House Manager. LIC809D, Appeal Rights and a copy of this report provided.