Facility Evaluation Report

On 11/15/21 at 2:45 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA was greeted by staff and granted entry. Licensee (LIC) Shonda Jones arrived a short later.

Facility was observed without any obstructions. Hand sanitizer was readily available to residents and visitors. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and no residents share a room. LPA checked residents’ medications. Medications are refilled as needed. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Residents files have updated emergency contact information. Administrator certification is valid.

1. Both fire extinguishers were last serviced 6/1/2020.

2. Bedroom #1: Window blinds is in disrepair, missing section of slats, and carpet observed with dark areas.

Bedroom #2: Window sill observed covered in dirt and sticky. Area of carpet in middle of bedroom observed with dark colored stain. Door observed punched in approximately 4" by 4". Bedroom #3: Carpet observed with dark areas. Garage: Exterior of garage door, door step plate, and garage floor is covered in dirt and stains. Back patio observed covered in dirt and stains.

3. Trash bin in kitchen and hall bathroom observed without tight-fitting lids.

Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC9909D.

Exit interview was conducted. A copy of this report and appeal rights were emailed to email on record with "Read receipt" to confirm receipt of this report.