Facility Evaluation Report

Licensing program Analyst (LPA) Albert Johnson conducted a pre-licensing tele-visit inspection on 6/14/2022.

LPA conducted a tour inside and outside of the care home. LPA observed the back yard with a secure fence, there was a table, umbrella, and adequate outdoor seating, and no pool or bodies of water were observed. LPA observed the back yard and perimeter of the care home to be free of clutter and debris and windows and screens were in good repair Inside the care home, LPA observed all hallways and passageways to be free of clutter or hazards. LPA observed bedrooms and living areas to be adequately furnished and LPA observed adequate supply of linens on hand. Tested water temperature in resident bathroom at 115 degrees F. LPA observed bathrooms to be in sanitary condition and maintained. Cleaning supplies and chemicals are stored in a locked cabinet.

LPA observed a sufficient supply of perishable and non-perishable food supply on hand, and there is a sufficient supply of eating, serving, and food preparation materials on hand as well. LPA observed a first aid kit and fire extinguishers maintained and ready for emergency use and a fire clearance is for 4 ambulatory clients. Smoke detectors are hard wired and care home has a functioning carbon monoxide detector.

Emergency exit and phone number are posted. LPA was sent a photo of all required postings. There are supplies and materials for activities. Medications and confidential paperwork will be stored in separate locked cabinets.

Pre-licensing passed and COMP III completed . Applicant has satisfied all requirements in accordance to per Title 22, California Code of Regulations