Senior Care Records.

Facility Evaluation Report

Hickory House, San Rafael12/08/2021Licence 216800419

Capacity6
Census5
Date signed12/08/2021 12:10:27 PM
The inspector’s account

Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Hickory House for the purpose of conducting an unannounced Required 1 year inspection. LPA was greeted at the door by Administrator, Lakeda Brown-Steward. Administrator granted access into the facility.

LPA toured the facility with the Administrator at 11:25 AM. The facility was clean and well organized. Smoke; fire; carbon monoxide all current. All exits unobstructed. Hot water tested at 115 F degrees. Medication and hazardous materials locked and stored away. Fresh and non-perishable food in adequate supply. Sufficient linens and hygiene products available for the clients. Disaster drill log current. Fire extinguisher was found to be last charged in July 2021. First Aid kit was inspected and found to be sufficient at this time. There is a pool on premises that had five feet gate all around, locked and inaccessible to clients in care. No firearms were present in the home at the time of the inspection. Medications were found to be stored according to regulations and inaccessible to clients in care. Bathrooms and clients bedrooms clean and adequately furnished. Grounds free of any apparent hazards. Toxins are stored in a locked cabinet inside the facility garage. Dangerous items were stored inaccessible to clients. There were an ample supply of cleaners, hygiene products and paper products available for clients. The bathroom designated for clients at the facility were supplied with hand soap dispenser. All client’s bedrooms have lighting & appropriate furnishings, and beds were outfitted with mattress pads on client’s beds as required by Title 22 Regulations

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has sufficient PPE supplies. Staff have had all PPE training required and have had N95 Fit testing.

No deficiencies observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report signed and emailed to the Administrator, Lakeda Brown-Steward.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction