Facility Evaluation Report

Licensing Program Analyst’s (LPA’s) J. Leffall and K. Kaur conducted an unannounced visit on 8/14/24 for the facility’s annual inspection. LPA’s met with Licensee, Zoria French. There is currently 1 resident who resides at this facility. LPA’s inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. LPA’s observed 2-day perishable and 7-day nonperishable. During kitchen tour, LPA’s observed kitchen window screen torn.

Fire extinguisher was purchased on 8/26/23. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. At 1:54pm LPA’s observed Detergent, Roundup and Disinfecting Spray unlocked in storage area next to staff room. LPA’s observed backyard gate to have a latch on the outside, preventing licensee to open backyard gate during inspection. LPA's observed gate getting stuck on ground, thus not allowing gate to open allowing enough clearance for exit.

LPAs completed a medication audit. Medications were stored in a locked cabinet in the kitchen/ dining area. MARs and medications were reviewed. At 3:54pm LPA’s observed PRN medication not documented with required information. Based on record review LPAs observed 1 out of 1 resident that had 2 medication dosage that were missing. A sample of staff files were reviewed to have CPR/First-Aid, Training, and Health Clearance. Resident file review revealed missing LIC 602 and TB clearance. LPA’s observed Admission Agreement, Personal Rights.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610 the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Exit interview conducted with Licensee and copy of report provided with Appeal Rights.