Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt and Anna Porter conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator Lereese Delouth, Continual Administrator's Certification expires 05/13/2027. There are currently 4 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. Water temperature was tested between 108 and 110 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

The facility is not performing quarterly disaster drills as required. Resident 1 does not have required annually updated medical assessment. Resident 1's Centrally stored medication record is not current/updated. Infection Control Plan and Emergency Disaster Plan are not documented as reviewed annually. LPA reviewed a sample of staff and resident records. The records were not organized and documents were not able to be located timely. Staff 1 does not have required Health screening. The facilities non perishable food supply is low. Resident 2's bedroom door is extremely dirty, in disrepair, along with hallway wall across from door, facility vents are extremely dusty.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Administrator Lereese Delouth, and copy of report left at facility