Facility Evaluation Report

Licensing Program Analyst (LPA) and Licensing Program Manager (LPM) Lauren Crocker arrived at the care home and met with Administrator, Shanice Downer, to follow-up regarding citations previously issued at the care home.

During visit, LPA and LPM toured the premises and reviewed documents. LPA and LPM observed concerns regarding cleanliness and repair of the care home, including cleanliness of floors and doors, cobwebs inside the shed in the yard and in the care home, urine containers not emptied, and tarp hanging from roof. LPA and LPM observed a vial of Xylocaine in a resident's room readily accessible for a resident who should not have access to medications according to their most updated medical assessment. LPA and LPM also observed accessible medications stored in the staff bedroom.

As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. A civil penalty in the amount of $250 was assessed for today's date due to repeat violation. Deficiencies are listed on 809-D pages.

Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.