Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with administrator and stated the purpose of today’s visit.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. There is a dining area off the kitchen and a formal living room and game room for residents. There are a total of four bedrooms and two bathrooms for residents. There is a locked shed in backyard inaccessible to residents in care.

LPA observed the temperature inside the facility was measured at 76.5 *F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 110.3 *F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed the fire alarm, fire extinguisher(s) were last inspected on September 6, 2023, smoke and carbon monoxide detectors, central heating, and air in the facility. A first aid kit and an emergency supply of food/water was observed. Sharps were observed to be locked up.

LPA reviewed four staff and three resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility.

LPA received the following updated documentation on today's date: LIC 308 Designation of administrator and copy of liability insurance.

Per the California Code of Regulations, Title 22 no deficiencies were observed or cited.

Exit interview held with Administrator. A report and LIC 811 (Confidential Names) was left at the facility