Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required Annual Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6035710735 expires 4/26/2024.

This facility is a single story building licensed to serve four (4) ambulatory residents of which 1 may be non-ambulatory at any given time. LPA and administrator toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 113.3 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers were last serviced on 4/10/2023. Smoke and carbon monoxide detectors are in compliance with fire safety. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. First aid kit was checked and is complete.

LPA reviewed four resident files and four staff files. A review of staff records indicates that all facility staff & other individuals who require caregiver background checks are fingerprint cleared and to the facility. LPA verified staff training for staff file reviews and all four staff have current First Aid Certificates.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no citations were issued during today's visit.

Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) given at the conclusion of the visit.