Facility Evaluation Report

Licensing Program Analyst (LPA) Kathrina Chin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Anna Mallari and Richard Sayat, Assistant Administrator and stated the purpose of this visit.

The facility is a single level structure and licensed for four ambulatory and one non-ambulatory residents.

LPA Chin was granted entry after completing the COVID 19 screening procedure. For this visit, there is one resident in care and three staff members on the floor. LPA toured the interior and exterior portions of the facility. There were four private resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid - floor mats. Hot water was measured at 110 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outdoor furniture and covered patio. The grounds were free of tripping hazards. Side exit door was self-latching and self-closing. LPA Chin reviewed the COVID 19 mitigation plan of the facility. LPA reviewed the mitigation plan.

LPA provided facility the general email address of the office: CCLASCPOrangeCountyRO@dss.ca.gov The facility will use the email address to send all incident reports and other general correspondence for Orange County Community Care Licensing Division Regional Office.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Anna Mallari and Richard Sayat, Assistant Administrator and copy of this report was left in the facility