Facility Evaluation Report

On 4/7/22 at 9:05 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. Co-Administrator Lori Wyatt and House Manager Joye Walker arrived a short time later. There were two staff and five residents present during the inspection.

LPA toured inside and outside of facility with staff. No obstructions or fire clearance issues observed. LPA observed COVID-19 precaution signs posted and screening at entrance. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bedrooms were checked and two of three bedrooms are shared rooms. LPA checked residents’ medications and observed the month's supply. Cleaning and PPE supplies were checked. Main PPE supply is stored at the main office. Food supply was observed sufficient. Sample of staff records checked for current health assessments. Administrator certification is valid.

The following deficiencies were observed:

1. Living room top window screen observed bent on bottom left and middle right sides.

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

LIC500, LIC610D (new revision), LIC400, LIC402

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. Due to COVID-19 precautionary measures, a copy of this report and appeal rights were emailed to email on record with "Read receipt" to confirm receipt of this report. LPA verified email on record is correct .