Facility Evaluation Report

Licensing Program Analysts (LPA's) Ruth Wallace and Brandon Panariello conducted unannounced Required 1 Year Annual Inspection Visit. LPA's met with Administrator and explained the purpose of the visit. There are currently 4 clients.

LPA's toured the facility with Licensee. LPA's inspected the physical plant including but not limited to the common areas, kitchen, dining area, resident bedrooms; resident bathrooms, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA's observed all surface walls, baseboards, and floors need to have deep cleaning. LPA's observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms need deep cleaning around baseboards, walls, and floors. Floor vent in dining needs to be cleaned. The hot water temperature was observed to be 109.0 F degrees Fahrenheit. LPA's observed there to be a sufficient amount of perishable and non-perishable food supply on hand. LPA 'observed knives and toxins to be locked away and inaccessible to residents. Smoke and carbon detectors were in good repair. Fire extinguisher inspected 8/30/2022 and first aid kit was current. LPA's checked medication storage and found medication to be locked away and inaccessible to clients. LPA's also conducted complete care tool domain tool. The facility mitigation plan was submitted to CCLD, and it was approved on 5/7/2021.

LPA Wallace requested the following updated documents to be submitted via email by May 2, 2023: LIC 400 - Client Cash Resources, LIC 402 - Surety Bond, and LIC 610-D Emergency Disaster Plan. ruth.wallace@dss.ca.gov

Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, one deficiency was observed and cited today. Failure to correct cited deficiencies by the noted due date; civil penalties may be assessed.

Exit interview conducted with Licensee. LPA's left a copy of report and appeal rights at facility.