Facility Evaluation Report

Licensing Program Analyst’s (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. Facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Deborah Johnston. The facility is currently licensed for six (6) ambulatory clients. During today’s inspection, there was a total of four (4) ambulatory clients in care..

LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected resident bedrooms. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens, hygiene supplies. Hot water temperature was compliant.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. Facility has swimming pool, The facility has a waiver allowing a sliding door to be unlocked to access the pool. The licensee honors the conditions for this waiver by ensuring that all of the clients are able to swim and maintaining her water safety certificate. Per staff no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) and first aid kit was present. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents.

Deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). Plans of Correction was jointly developed with Licensee. An exit interview was conducted with Licensee, to whom a copy of this report, the LIC 809-D and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.