Facility Evaluation Report

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 12:25 p.m. to conduct an unannounced annual visit. LPA met the with Caregiver Mary at the front door and was granted entry. The Clinical Director Michelle Hayes arrived 12:52 p.m. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) ambulatory residents with 3 ambulatory residents in care.

Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies.

Physical Plant and Environmental Safety : The facility temperature read at 74 degrees. The facility consists of 3 resident bedrooms, and 3 bathrooms, living room, kitchen, gym, recreational area, theatre and backyard. The bedrooms are furnished with, lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 120 degrees within regulation requirements. The living room and kitchen are clean and clear of obstruction. The medications are stored in a locked cabinet in the clinical area near the nurses station and inaccessible to residents. The SRF and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguishers and are in working order.

Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings.

Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, psychiatric evaluation, client rights, and admissions agreement.