Facility Evaluation Report

On 5/26/22 at 9:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. Administrator was unavailable for inspection.

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 do not share bedrooms. LPA checked residents’ medications. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information. Administrator certificate is valid.

The following deficiencies were observed:

1. Storage unit in patio where two shovels, two metal rakes, one garden hoe, and one hand cultivator tool are kept was observed unlocked and accessible.

2. Bedroom #1 and 2, living room, and office window screen frames observed with a bent side. Bedroom #4's left side window screen missing. Bedroom #1 and 2 window curtain rods observed bent. Right side exterior fire exit gate observed unable to open and close with ease. Left side exterior fire exit gate observed with missing pull string, gate is not latching when closing, and gate is not opening and closing with ease.

3. S1 does not have a signed health assessment report and has been working since 9/15/2020.

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

LIC500, LIC400, LIC402, LIC610D (new revision)

Deficiencies are being cited based on LPA's observations 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 Lead staff Billie Goodman, whose signature confirms receipt of this report.