Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct a Required 1-year Annual Inspection Visit. LPA met with Administrator and confirmed no staff or clients have experienced COVID symptoms within the last 10 days. LPA explained the purpose of today’s inspection to Administrator. LPA was allowed entry into the facility that is licensed to serve a total capacity of 30 ambulatory clients.

LPA and administrator 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 for clients is maintained at 70 degree Fahrenheit. LPA observed The hot water measured 111.0*F in kitchen sink which is within the required range of 105-120*F. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7 day non-perishable and 2 day perishables foods. LPA observed cleaning supplies locked up in linen closet inaccessible to clients in care. Well water checked for bacterial analysis on 8/16/2022.

Fire extinguishers were last serviced on 06/20/2022. Facility is conducting quarterly fire drills, last one conducted 7/1/2022. LPA observed mitigation plan completed. First aid kit observed to be complete. Emergency Disaster Plan completed on 08/31/2021. LPA observed all exits to have alarms and an unlocked exit in the backyard. There is a pool which is empty at this time, gated is locked.

LPA reviewed 6 of 20 resident records. LPA reviewed 4 staff records and all have health screen and TB results. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed current first aid certificates and are current. Administrator Certificate expired 1/6/2022.

LPA Wallace completed infection control domain and observed no issues or concerns.

One deficiency was observed or cited from the California Code of Regulations, Title 22.

Exit interview conducted with Administrator. A copy of reports and appeal rights given to administrator.