Facility Evaluation Report

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Annual Continuation inspection at the facility and met with caregiver Gloria Mendoza and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 863 7630.

The facility consist of six bedrooms(#1, #4 and #6 are for staff), three bathrooms,(one in bedroom #2, and #5), living room, dining room, kitchen and enclosed outdoor patio located in the back yard with washer and dryer, attached garage(storage and overflow of food).

On 09/02/21 LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication are locked in staff room #6. The smoke detectors/carbon monoxide detector are operable. The Fire alarm system has a pull switch, and there is one fire extinguisher located by the kitchen/dining room area. The mitigation plan was approved on 04/09/2021.

During todays visit the Infection control domain was used and the following areas were observed/inspected: The facility has postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with thermometer, hand sanitizing gel and masks were located at the front entrance of the facility. The water temperature was tested and measured at 120 degrees F.

The following deficiencies were cited according to California Code of Regulations, Title 22, Division 6, Chapter 8. Appeal rights given, and a copy of the LIC 809 was given during the exit interview.