Senior Care Records.

Facility Evaluation Report

Seymore Adult Residential INC, San Bernardino03/18/2024Licence 361881228

Capacity4
Census2
Date signed03/18/2024 04:35:06 PM
The inspector’s account

Licensing Program Analyst (LPA) Bianca Wolcott arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by Lezzavier Jones and granted entry. Mr. Jones, contacted Toniette Seymore (Administrator) which arrived shortly after. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. The facility has 4 client bedrooms, 3 bathrooms, kitchen, dining area, living room, laundry room, attached garage, and backyard. LPA completed a walk through of the facility and review of records.

Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents. Lighting is sufficient for safety and comfort. Water temperature measured 115 within range. LPA observed a locked cabinet under kitchen sink with cleaning supplies. LPA observed a locked hallway closet with cleaning supplies, chemicals and sharps.

Fire extinguishers are charged, mounted. All outdoor and indoor passageways are free of obstruction. Night lights and emergency lighting is present. A locked area is provided for medications. There is a telephone working at this location. The LIC 610E, emergency disaster plan is maintained. Emergency Drills and Fire Drills are being maintained. The facility has a current written definitive plan of operation. The facility is maintained in conformity with the regulations adopted by the state fire marshal. P&I was accessed and verified by Administrator. Refrigerator is 40 degrees, and freezer is -0 degrees.

Personnel Records/Training/and Staffing-. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. LPA observed First Aid Book available at facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction