Facility Evaluation Report

On 10/12/22 at 8:40 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. Administrator arrived a short time later. There were two staff and two residents present during the inspection.

Facility was observed clean and without any obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. 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. Staff records were reviewed for good health. Residents files have updated emergency contact information. Administrator certification is valid.

1. S1 did not have a completed health screening report and has been working since 1/30/21.

The following forms are to be submitted to CCL within 2 weeks:

Deficiency is being cited based on LPA observations, record review, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.

Exit interview conducted. A copy of this report was given to Administrator Ronald Duran, whose signature confirms receipt of this report.