Facility Evaluation Report

Licensing Program Manager(LPM) Liza King and Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility to conduct a case management on a Prelicensing inspection on Alexa Home. LPM met with caregiver who contacted the Administrator, who arrived at 9:30. Ast Admin arrived at 8:30am. The purpose of the visit was explained.

Current census is 5 residents, 0 are receiving hospice, 4 of 5 are receiving home health care specifically PT, 4of5 are insulin dependent with a sliding scale. No current catheters, No current colostomy and No current Wounds.

LPM verified staff present are fingerprint cleared. LPM toured the facility which included a staff room with 2 sets on bunk beds, and 4 resident rooms. The exterior of the building shows one screen which needs to be replaced and overgrown grass (given the recent rains this is not a concern). The interior living area is clean. Bathroom 1 needs the splashgaurd in the shower repaired, bathroom 2 has pink mold growing in the shower. The bathroom has the necessary DME. Facility has required linen, lighting and furniture.

Facility appeared clean and well kept otherwise.

The facility has the necessary food, however the proper labeling of food once opened is not being completed. Breakfast consisted on a ham and cheese omelet, pancakes and sausages.

All LIC602s are signed off by the Medical group out of San Rafeal, documentation of medical visits occurring in the home are documented in the electronic record.

R2 was observed to need assistance repositioning in bed which would require bedridden clearance. The facility currently has no fire clearance for this.