Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Debra Shandy, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility is a licensed Level 2 home vendorized through Alta California Regional Center. There are (5) clients who reside at the home. LPA observed (1) resident in the common area and the remaining (4) residents to be in their rooms. LPA observed Steven Shandy present as second staff.

LPA and Administrator toured the interior of the facility including the common areas, client bedrooms, bathrooms, kitchen, laundry/garage area observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters throughout and updated visitation posters will be placed on the front door. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 11/16/2021. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply to include goggles, masks, gowns, shields, gloves and sanitizer. LPA and Administrator discussed vaccination status of residents and staff as well as visitation protocols per PIN 21-40. Administrator to post signage the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry.

LPA obtained an updated copy of LIC308 during today's inspection.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator. Administrator was informed that a subsequent annual inspection could be conducted on/around 2/24/2022.