Facility Evaluation Report

On 9/15/22 at 8:50 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. Licensee/Administrator Hilda Garces arrived about 30 minutes later.

LPA conducted facility tour with staff. No fire issues or obstructions 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. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information. Staff files checked for health assessments. Administrator certificate is valid.

The following deficiencies were observed:

1. Hot water in hallway bathroom measured at 122.9 degrees F.

2. LPA observed one can of comet cleaner accessible in cabinet under kitchen sink; storage unit in garage where all chemicals are stored was observed with padlock, but padlock was not secured making the chemicals accessible; kitchen drawer where knives are kept was left unlocked and accessible; and two knives were left on top the cutting board on top the kitchen counter.

3. Window screen frame for bedroom #1 was observed bent in the middle of the right side.

4. S1 did not have a health screening completed and has been working in the facility since 6/24/22.

The following forms are to be submitted to CCL within two weeks: LIC500, LIC610D, LIC400, LIC402

Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee Hilda Garces, whose signature on this form confirms receipt of these documents.