Facility Evaluation Report

On July 28, 2023, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a 1 year required annual Inspection. LPA met with Kang, the Program Director and explained the reason for the visit.

Kang and LPA conducted the Covid infectious Control questionnaire with no advisories.

LPA and Kang toured the facility. The census is 11 at this time. The facilities Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 74 degrees F which is within range. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Resident bedrooms and bathrooms were toured. There are 15 single bedrooms single suites. All rooms had the required items of furniture. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. First Aid Kit was complete.

There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and pKotential hazards. T here’s a centralized storage area for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log and was completed. LPA 2 reviewed 2 staff files and 2 client files. Both client files had the updated correct signed documents in them. Staff files had the updated information in them as well.

Per California Code of Regulations, Title 22, No violations were observed. No citations were issued at this time.

The Program Director shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensing no later than August 28, 2023.

An exit interview was conducted and a copy of this report was left at the facility