Facility Evaluation Report

On 6/14/22 at 12:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. Co-Administrator Gerald De Claro and House Manager Rosemary Dejesus arrived a short time later.

LPA conducted tour with staff and did not observed any obstructions. No fire issues observed. 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. Bedrooms were checked. Two residents share a room and three residents have individual bedrooms. LPA checked residents’ medications. Cleaning and PPE supplies were checked. Food supply was observed in adequate supply.

The following deficiencies were observed:

1. Administrator does not have current Administrator certificate.

2. Facility does not have a wound care plan for R1.

3. LPA observed exterior fire exit gate with missing gate lever for latch and one kitchen drawer front is missing a side piece exposing sharp wood edges.

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

LIC500, LIC400, LIC402, LIC610D (new revision)

Deficiencies are being cited based on LPA's observations and interview in accordance with the California Code of Regulations, Title 22, see LIC809D.

Exit interview conducted. A copy of this report and appeal rights were given to Co-Administrator Gerald De Claro, whose signature confirms receipt of this report.