Facility Evaluation Report

On 9/3/21 at 10:30 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. Licensee Helen Houck arrived a short time later.

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. Hand washing posters were observed by the bathroom sinks. All residents have private bedrooms. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate 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.

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

LIC500, LIC400, LIC610D, LIC308, and surety bond.

Exit interview conducted. A copy of this report was emailed to HELENHOUCK@SBCGLOBAL.NET with read receipt to confirm receipt of this report.