Facility Evaluation Report

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Facility Manager Leilani Telebrico and explained the reason for the visit. Physical Plant was toured, sample record of medications were reviewed, and food supply was inspected.

LPA and Facility Manager toured the home and inspected (4) client bedrooms, (1) staff room, (1) client bathroom, (1) staff bathroom, living room, dining room, kitchen, stock room, 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 in the hallway and measured at 129.6F which is higher than the required 105F - 120F degrees. 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 hallway of the home. There is a fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the locked stock room and are inaccessible to clients. Cleaning supplies and toxins are locked in the stock room and are inaccessible to clients. First Aid kit was fully stocked with current manual. Staff were observed checking visitors temperature at the time of entry.

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 were observed.

(6) out of the (6) client medications were reviewed. Medications are centrally stored in a cabinet located in the living. 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.