Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA and staff toured the facility. Facility is a single story home with an attached 2 car garage with 5 bedrooms, 3 bathrooms, kitchen, dining room and a living room with a fireplace. LPA observed the fireplace is screened. The fire extinguisher in the kitchen is charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed that the front left burner on the 4 burner gas burner stove does not light unassisted. LPA observed knives are kept locked under the kitchen sink. LPA observed the medications are kept locked in a kitchen cabinet. LPA and staff toured the resident rooms. 4 of the resident rooms are private and one is shared. LPA observed all resident rooms are clean and organized. All resident rooms had the required furnishings and bed linens. LPA toured the garage. The garage is kept locked and used for storage of extra supplies and food. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all 3 bathrooms are clean and operational. Hot water measured 105.8 degrees Fahrenheit in all 3 bathrooms. LPA and staff toured the backyard. No bodies of water observed. There is a table with an umbrella and chairs for residents to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed 6 resident files. 1 out of 6 residents did not have a current medical assessment (LIC 602A, physician's report). Resident 2 (R2) did not have a current physician's report. LPA reviewed 6 resident medications, no discrepancies observed. LPA reviewed 4 staff files. 2 out of 4 staff did not have the required 20 hours of annual training. Staff 1 (S1) and Staff 2 (S2) did not have any current annual training. All 4 staff members had current CPR/First Aid training. No other discrepancies observed. Deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interviewed was conducted and a copy of the report along with appeal rights was provided.