Facility Evaluation Report

Licensing Program Analyst (LPAs) R. Campbell and T. White conducted an unannounced Annual 1-Year Required visit on this date. LPAs met and toured with Executive Director Sara Mackedsy. The facility’s fire clearance was approved for 04/2014. Upon entry LPA was screened for COVID symptoms, a sign in/sign out procedure was observed as well as facility staff wearing masks.

LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

The last fire drill occurred on 06/26/2022. Fire extinguisher was last serviced on October 26, 2021. First aid kit was observed to be complete.

LPA reviewed 5 out of 5 staff files and the facility has sufficient staffing to provide the services needed to meet the residents’ needs. 5 of 5 staff have current first aid training but signed employee rights were not found in employee files. One staff did not have a health screening. The facility serves residents with dementia and staff have received the necessary training hours specific to dementia. LPA reviewed 5 of 5 residents’ files and a sample of residents’ medication logs were reviewed.

- During record review, LPAs observed 1 of 5 staff not associated to the facility.

- During record review, LPAs observed no signed employee rights forms in 5 of 5 staff personnel file.

-During record review, 1 out of the 5 staff did not have a health screening.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 ,and California Health and Safety Code. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.