Facility Evaluation Report

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 4:22 p.m. to conduct an unannounced annual visit. LPA met Caregiver Zion Wilson at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for 4 ambulatory residents with 4 ambulatory residents in care.

Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies.

Physical Plant and Environmental Safety : The facility temperature read at 75 degrees. The facility consists of four (4) resident bedrooms, and two (2) bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with tv, lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 112 degrees within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the hallway and inaccessible to residents. The ARF and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguishers and are in working order.

Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings.

Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, IPP, ISP, client rights, resident’s cash resources. and admissions agreement.