Facility Evaluation Report

Licensing Program Analysts (LPAs) Sarah Hurt and Kamaldeep Kaur conducted an unannounced annual inspection. LPAs met with Facility staff, Rebecca Wilson. Administrator’s Certification for Trieg’e Surratt expires on07/30/2026. There are currently 3 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA’s observed three fire extinguishers located throughout the facility not within the safety regulation period. Water temperature was tested at 84 degrees, and 78 degrees (below required temperature) The facility is not performing disaster drills as required. Staff 1 and Staff 2’s Personnel record is not available for review. Resident 1’s medical assessment is not complete and updated. Medication review was conducted. Centrally Stored Medication Record og was not complete.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

An exit interview was conducted with staff. Report signed on-site; a copy of this report, 809D with appeal rights were provided.