Facility Evaluation Report

On 2/28/22 at 8:50 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by staff. Co-Administrator (ADM) Cheryl McCraw arrived a short time later. All four residents were present during inspection.

LPA toured facility with staff and ADM. LPA did not observe any obstructions or fire clearance issues. LPA observed COVID-19 precaution signs posted and sign-in table at entrance. 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. Cleaning and PPE supplies were checked. Administrator certification is valid.

The following deficiencies were observed:

1. Hot water in hall bathroom measured at 130.1 degrees F.

2. Bedroom #1 ceiling fan blades observed covered in dust. Bedroom #3 door observed with an 4" x 2" inch hole and right wall outside bedroom #3 door observed with a 2" x 1" hole.

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

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. Due to COVID-19 precautionary measures, a copy of this report and appeal rights were emailed to email on record with "Read receipt" to confirm receipt of this report. LPA verified email on record is correct .