Facility Evaluation Report

On 8/22/2022 at 11:50 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/Administrator Helen Houck arrived a short time later.

LPA conducted tour with staff and did not observe 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 and residents do not share bedrooms. LPA checked residents’ medications. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information. Administrator certificate is valid.

1. Bottom panel of sliding door in living room observed broken with sharp edges and screen door mesh observed with three holes torn approximately 1.5 inches by 1.5 inches

A deficiency is being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D.

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

LIC500, LIC400, LIC402, LIC610D (new revision)

Exit interview conducted. A copy of this report and a Plan of Correction was reviewed and developed with Licensee Helen Houck, whose signature confirms receipt of this report.