Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA explained purpose of today's visit with administrator. LPA observed required COVID measures were observed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 30 clients and temperature was taken,

LPA and senior assistant clerical The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility conducts fire drills monthly. LPA observed the thermostat temperature inside the facility hallway was measured at 74 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 108.5 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed a pull alarm system, fire extinguisher(s) were inspected 4/26/22, smoke and carbon monoxide detectors, central heating and air in the facility. Mitigation Plan was submitted and approved.

LPA reviewed four (4) Staff and four (4) Client files that were locked and readily available for review. Staff had current First Aid/CPR certificates. One staff (S1) was not fingerprint cleared and never associated to facility.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, there was one deficiency cited during this visit. Exit interview held with administrator. Copies of reports and appeal rights were given to administrator.