Facility Evaluation Report

On 9/19/22 at 12:15 PM, 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/Administrator Helen Houck arrived a short time later.

LPA toured inside and outside of facility. 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 sinks. Residents each have a private room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Bulk of PPE supplies are kept at a separate facility. Residents files have updated emergency contact information. Administrator certification is current.

1. S1 is not associated to the facility and has been working since 4/1/22.

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

A deficiency is being cited based on LPA interview, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A civil penalty is being assessed in the amount of $100 per day, for a maximum of 5 days, for a total of $500. See LIC421BG for more details.

An exit interview was conducted. A copy of this report and appeal rights were given to Licensee Helen Houck, whose signature on this form confirms receipt of these documents.