Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met Administrator Daisy Moreno and explained the reason for the visit. Physical Plant was toured, sample record of medications was reviewed, and food supply was inspected.

· LPA and Administrator/Staff toured the home and inspected (4) client bedrooms, (1) office room, (3) bathrooms, living room, dining room, kitchen, and den area. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the back patio. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 and bathroom and measured between 117.3 6F – 118.7F which is within the required 105 - 120 degrees. Kitchen water temperature measured 122.9 which is not within range. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen, and the linen is in good condition. Smoke detectors are intertwined with carbon monoxide detectors and were observed throughout the facility. There is a fire extinguisher located in the office which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the office and are inaccessible to clients. Cleaning supplies and toxins are locked in a closet in the office and are inaccessible to clients. First Aid kit was fully stocked with current manual.

· Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

· Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed.

· (3) out of the (4) client medications were reviewed. Medications are centrally stored in the office.

· Staff and Client files were not reviewed during today's visit.

· Wrought iron on window adjacent to front door needs new lock as it is missing.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit. See 809D Exit interview held and a copy of the report was provided.