Facility Evaluation Report

On 3/28/22 at 9:35 a.m., Licensing Program Analyst(LPA) Jewel Baptiste conducted an unannounced visit for the purpose of an annual required visit with focus on the infection control domain, food, and medication review . LPA met caregiver Tatiana Defell, who assisted with today's visit. LPA made a complete tour of facility with Staff 1. At 10: 40 administrator Lourdes arrived and assisted with the rest of the visit.

Facility is licensed to serve 4 over the age of 60 of which 4 is non-ambulatory. Age exception waiver approved for 1 residents. Facility is a one story house with 2 Living room, dining room, kitchen, 4 bedrooms, 1 office and 2 1/2 bathrooms. Facility has multiple fire extinguishers, carbon monoxide detectors throughout the facility.

LPA inspected all client rooms, observing them to be clean and appropriately furnished. Bathrooms were sanitary, functional and contained all necessary grab bars and non-slip mats. The facility is maintained at a comfortable temperature and hot water measured between 106-106.9 degrees Fahrenheit.

The kitchen was clean and adequately supplied with 2 days perishable and 7 days of non-perishable foods. Knives and cleaning supplies were locked and properly secures. Medications are located in a locked cabinet and appeared to be stored and administered according to doctors orders at the time of this visit.

LPA observed emergency disaster plan and infection control signs posted. last emergency drill was conducted on 3/21/22 and earthquake drill 3/07/22.

Staff files were reviewed for the two employees present at the time of visit, both were complete and current. Administrators certificate #6005394740 expires 8/4/2023.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to administrator Lourdes..