Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee Mila Green, Continual Administrator's Certification expires 12/16/2025. There are currently 4 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete.

LPA observed area around facility upstairs toilet to be in disrepair. LPA observed chemicals/ cleaning supplies in upstairs laundry room accessible to residents. LPA observed area around downstairs shower needs cleaning. LPA observed extra bed frame and mattress in Resident 1's bedroom not being used. Water temperature was tested at 129 degrees. The facilities Infection Control Plan is not available for review. The facilities Emergency Disaster Plan is not updated or on correct form. Staff 1 and Staff 2 do not have current First aid training. LPA observed facility fire extinguisher last serviced 11/2023.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Licensee, Mila Green and copy of report left at facility