Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with Administrator and explained purpose of visit. Administrator Certificate expires 6/1/2024.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 111.2 degrees Fahrenheit which is within the required range of 105 to 120 degrees.

Fire extinguishers last inspected on 11/2/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 2/6/2024.

LPA reviewed two resident files and four staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

LPA requested the following updated documents to be submitted via email to community care licensing by February 14, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Surety Bond. ruth.wallace@dss.ca.gov

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited during this visit.

Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) were left at facility.