Facility Evaluation Report

On 5/17/22 at 10:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. Licensee (LIC) Susan Baal arrived a short time later.

LPA conducted tour with staff and did not observed any obstructions. No fire issues observed. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and residents share bedrooms. LPA checked residents’ medications. Cleaning and PPE supplies were checked. Administrator has current certificate. Staff records checked for good health.

The following deficiencies were observed:

1. Padlock for cabinet under kitchen sink was hooked into latch, but was not locked and was accessible to the two cans of Comet cleaner inside the cabinet.

2. Hall bathroom faucet observed with water leaking. Sliding door observed not able to be opened or closed with ease.

The following updated forms to be sent to CCL within 2 weeks: LIC500, LIC400, LIC402, LIC610E

Deficiencies are being cited based on LPA's observations and interview in accordance with the California Code of Regulations, Title 22, see LIC809D.

Exit interview conducted. A copy of this report and appeal rights were given to Licensee Susan Baal, whose signature confirms receipt of this report.