Facility Evaluation Report

On 2/17/22 at 11:15 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. LPA met with Licensee/Administrator Wendy Silva. There was one resident present during the inspection.

LPA toured inside and outside of the facility with Licensee. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed next to the sinks. Bedrooms were checked and no residents share a room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. There were no fire clearance issues. Administrator certification is valid.

The following deficiencies were observed:

1. S1 does not have a health screening. S1 started working in the facility on 2/16/16.

2. Hot water in hall bathroom measured 121.7 degrees F.

3. Both fire exit gates outside the facility were inaccessible from inside backyard. Licensee could not open the either gates from inside yard. Staff walked around to front yard to push exit gates open. Left exit gate latch was nonoperational and right exit gate had enterior latch in locked position and only accessible from exterior side of gate.

4. Dining room window screen frame observed bent on bottom end.

The following updated forms to be sent to CCL within 2 weeks:

LIC500, LIC610D (new revision), LIC400, LIC402, LIC308