Facility Evaluation Report

On December 2, 2021, at 2:55pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a required annual inspection. LPA met with Elaine Lambert, Caregiver and explained purpose of inspection. Prior to initiating the inspection LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask. Elaine and LPA completed the inspection tool questionnaire with no issues or advisories to report.

Administrator certificate is valid, expiring 3/21/2022. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6.

Administrator shall submit the following documents to update the Regional Office files and submit them to Community Care Licensing by 1/2/2022:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility

Exit interview conducted and a copy of this report given to Elaine Lambert