Facility Evaluation Report

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA met with staff Kathleen Davis who was informed for the purpose of the visit and was granted entry. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. The following was observed:

Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements recorded at 111 and 117 degrees. Detergent and cleaning supplies were locked in a cabinet located under the sink. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Two (2) client files were reviewed during the inspection. Client One (C1) and Client Two (C2) did not have a current Physician's Report for review. A deficiency will be issued under Title 22 regulations 80069(b)(1) along with a plan of correction. LPA was not able to review C2's client records due to records were not complete, current, and maintained at the facility. A deficiency will be issued under Title 22 Regulations 80070(a) along with a plan of correction. LPA reviewed the facility's emergency and disaster plan. Facility did not have an infection control plan for LPA's record review. A deficiency will be issued under Title 22 Regulations 85095.5(c) along with a plan of correction. LPA observed emergency supplies in the garage and hallway closet and first aid kit with all required items. Client medication was centrally stored and locked in a medication cabinet located in the kitchen. LPA reviewed medications prescribed to one (1) client and found all medication with required labeling found to be in place. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator Mary Martin does not possess a current administrator's certificate. A deficiency under Title 22 regulation 85064(b) and a Civil Penalty will be issued along with a plan of correction.

An exit interview was conducted where a copy of this report, LIC 809-D, LIC 811, Civil Penalty Assessment, and Appeal Rights was provided to Kathleen Davis