Facility Evaluation Report

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met DSP Noelle Clarke and explained the reason for the visit. Administrator S'Halana Carter arrived shortly thereafter. Physical Plant was toured, sample record of medications were reviewed, and food supply was inspected.

LPA and Administrator toured the home and inspected (4) client bedrooms, (2) bathrooms, living room, dining room, kitchen, and attached garage. 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 (hallway) and measured at 105.5F, water temperature was also measured in bathroom #2 (client bedroom) and measured at 121.8F which is above the required 105F - 120F degrees (Water temperature was adjusted during visit). 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 were observed throughout the facility and were tested and operable during the visit. There is a carbon monoxide detector located in the living room. There are multiple fire extinguishers located throughout the home which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the hallway and are inaccessible to clients. Cleaning supplies and disinfectants are locked in the hallway 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.

Staff were observed wearing masks and screening visitors at entry.

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

(3) out of the (3) client medications were reviewed. Medications are centrally stored in a cabinet located in the hallway. Medications are documented properly and given as prescribed.

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

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.