Facility Evaluation Report
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator Antwanique Walker, Continual Administrator's Certification expires 01/22/2027. There are currently 4 residents who reside at this home and there is 0 residents on hospice at this time. 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. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.
Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 111 degrees. First Aid kit is on site and complete.
Staff 1 did not have CPR/First aid card available for review. Resident 1 did not have annually updated Needs and services plan. Infection Control Plan needs to be more detailed related on training staff. LPA observed dust in bedroom vent, and also in resident bedrooms. LPA observed hallway bathroom vanity cabinet not in good repair. The facilities Centrally stored Medication record does not include amount of refills. LPA observed 2 window screens in backyard area not properly secured to window. LPA observed bleach disinfecting wipes accessible to client in bedroom.
The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.
LPA's 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 Antwanique Walker, and copy of report left at facility
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction