Facility Evaluation Report
Capacity4
Census1
Date signed09/28/2021 08:44:28 AM
Unannounced annual visit utilizing the infection control domain was performed by LPA Michael Smith. Contact with Patricia Johnson.
A review of staff records on 9/27/21 indicates that all facility staff and other individuals who require caregiver background checks have received criminal record clearances.
As a result of this visit, there were no deficiencies. However, 2 technical violations were issued.
Small family home with one (1) resident. Facility has requested N95 masks.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction