Facility Evaluation Report

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Nancy Guillen for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Administrator (AD) Alexis Le and discussed the purpose of the inspection.

LPAs reviewed Infection Control requirements. At about 1:10PM, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, and garage and observed the following: Structure: facility is a 3-bedroom, 5-bathroom, 2-story house with an attached garage that is being used for activities and storage. There is a back yard with a patio cover for the clients. Client Bedrooms: the 3 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Furniture for each client bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature tested between 109 and 119 degrees F in the 3 clients bathrooms. LPAs inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and laundry room. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 2:10PM, LPAs reviewed 4 client files and 5 staff files, interviewed 2 clients and 2 staff, inspected medications for 4 clients, and inspected client property and property logs for 4 clients. During the inspection, LPAs and AD observed the following: based on admission and documents, licensee did not ensure S1 had first aid training.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.