Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 5/29/24 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four bedrooms and one bathroom for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathroom was in sanitary condition and properly maintained.

LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed six (6) resident files and two (2) staff file. Facility has a current copy of certificate of liability insurance and LPA obtained a copy.

As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were assessed as a result of today's visit. Deficiencies are listed on 809-D pages.

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