Facility Evaluation Report

At approximately 1:55 p.m. on 05/12/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff #1 (S1) and disclosed the reason for the visit. At approximately 2:10 p.m. S1 called Administrator (S2). LPA spoke with S2 and disclosed the reason for the visit. S2 stated that due to an emergency, they could not come to the facility today. LPA informed S2 that an administrator or designated representative must be available at the facility at all times. S2 requested the inspection be rescheduled for Monday. LPA stated the inspection must be conducted today. LPA asked if S1 could sign in S2’s absence. S2 refused. LPA and S1 toured the facility inside and out.

The facility was last visited on 05/24/2019 for a an annual inspection. It is a single story building with 5 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 1 may be bedridden. The facility serves a resident with cognitive impairment. Approved hospice waivers for 2. The facility uses surveillance cameras inside and out.

Entry: LPA observed a maintained front yard. Once inside, LPA observed postings for confidential complaints, resident councils, resident rights, COVID policies, facility license, and two Administrator certificates. The certificates expired on 05/09/2020 and 06/21/2020. At 3:03 p.m. LPA conducted a record review of current and pending administrator certificates at https://cdss.ca.gov/inforesources/community-care/administrator-certification/administrator-information/active-certificates . LPA did not see either administrator listed. LPA called a secondary Administrator (S3) at 4:54 p.m. S3 stated all documents were submitted one year ago. LPA will confirm proof of documentation on 05/16/2022.

Screening: LPA was not screened for infectious disease upon entry. The facility did not have a screening station. S1 and staff #4 (S4) were observed without a mask for the duration of the inspection. The facility does not have a screening station.