Facility Evaluation Report
On 08/04/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Post-Licensing Inspection. LPA introduced self, stated that purpose of the visit and was allowed to enter the facility. LPA met with Administrator, Merilyn Bergstrom.
LPA conducted a tour inside and outside the facility. LPA observed the following:
Facility currently has 6 residents. Facility observed to be clean, odor free, and at a comfortable temperature. The dining room and living room were furnished well with adequate seating and lighting. Resident rooms appeared clean and had all required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars and non-skid mats. Hot water measured at 116 degrees F in the shared bedroom and 115.5 degrees F in the hallway bathroom. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Knives/Sharps observed to be locked and inaccessible. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.
Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted on 07/18/2023. All chemicals observed to be locked and secure. Medications observed to be locked in a closet and administered as prescribed.
No deficiencies issued during today's visit. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Merilyn Bergstrom, whose signature on this form confirms receipt of this document.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction