Senior Care Records.

Facility Evaluation Report

Pacific Pathway, San Rafael01/20/2023Licence 216801066

Capacity6
Date signed01/20/2023 10:42:13 AM
The inspector’s account

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 01/20/2023 to conduct a required 1 - year inspection. This inspection is focused on the infection control practices and procedures of this care facility. LPA met with administrator, Qiuming Zhai. Upon arrival nobody was present at the facility. LPA called administrator who arrived shortly. Clients were attending day programs.

LPA toured building and grounds which were clean and in good repair. Exits and walkways were clear from obstructions. COVID postings and screening materials were present at the front entrance. High touch surface areas are disinfected daily. Bathrooms had necessary grab bars and nonslip flooring. Facility has a sufficient amount of perishable and nonperishable food. Sufficient personal protective equipment was available to support a client in isolation. Toxins were locked and secured. Medications were locked and secured. Fire extinguishers were charged and current. Staff have been given infection control training. Staff and clients are fully vaccinated.

LPA is requesting the following documents be submitted to Community Care Licensing within 30 days of today's inspection:

LIC 400 Affidavit regarding client cash resources

Exit interview conducted with administrator and a copy of this report emailed to the facility.

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