Facility Evaluation Report
Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct an Required 1 Year Annual Inspection Visit. LPA met with house manager and explained the purpose of the visit.
LPA and house manager inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 108.8 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. LPA was able to review a current Surety bond for the facility, bond expires on December 1, 2024. Fire extinguishers inspected 8/5/2022 and smoke detectors are operational. LPA observed carbon monoxide detectors in the facility. Fire drill was conducted on 8/31/2022.
LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 3 resident and 3 staff files, including criminal record clearances. The first aid kit was checked and is complete.
LPA requested the following documents to be submitted via email by October 25, 2022: LIC 400, Copy of Surety Bond, LIC 500, LIC 610D, and Facility Program/Plan of Operation. ruth.wallace@dss.ca.gov
No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.
Exit interview conducted with and appeal rights given.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction