Facility Evaluation Report, 09/21/2021 — Allen's Care Home, Sacramento CA

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 09/21/2021 at 11:19 AM. LPA Martinez met with Melvina Allen and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations.

The current assigned administrator does not have a current administrator certificate. The licensee shall appoint an administrator that holds a current administrator certificate by 09/22/2021 The licensee shall provide LPA Martinez a copy of LIC 200, LIC 500, LIC 308, LIC 501, LIC 503, and a current administrator certificate, copies of administrator's completed education transcripts by close of business day 09/22/2021.

This facility is licensed for six residents. There are currently 6 residents who reside at this facility. LPA Martinez toured the facility with Melvina Allen on 09/21/2021 at 12:00 PM.

LPA Martinez reviewed 6 out of 6 resident files. Resident files were not up to date. Resident 1's file did not include a LIC 601 and P&I documents, and had an incomplete LIC 602. Resident 2's file did not include a LIC 601 and P&I documents and had an incomplete LIC 602 and. Resident 3' file did not include LIC 601 and P&I documents and had an incomplete 602. Resident 4's file did not did not include LIC 601 and P&I documents and had an incomplete 602. Resident 5's file did not did not include LIC 601 and P&I documents and had an incomplete 602. Moreover resident 5 did not have a discontinued medication order for Famotidine 40 MG. Resident 5's Medication Administration Record (MAR) was not filled out for the month of September 2021. LPA Martinez will return at a later date to review other resident medication files. Resident 6's file had an incomplete 602. 3 out of 3 employee files did not have a current first aid certificate. 1 out of 3 staff did not have a health screening form (LIC 503).