Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with the administrator and explained the purpose of the visit.

LPA Wallace and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 4 bed facility with a current census of 4. Facility has 5 bedrooms, 4 of which are occupied by clients in care. Facility also has 2 bathrooms. There are no obstructions to emergency exits noted. A pool is located outside and secured by appropriate size fencing. There are 2 tool sheds located outside, locked, and inaccessible to clients in care. LPA also conducted the infection control domain tool.

The facility has an approved COVID Mitigation plan LIC 808 form in place. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a COVID-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA reviewed 2 resident files and 4 staff member files. All staff are fingerprint cleared and have current first aid certificates. All residents have required documents for community care licensing (CCL).

Water temperature reads 109.4*F in the bathroom and room temperature reads 72*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was last serviced on 10/18/2022. Facility has an emergency food and water kit.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator.