Facility Evaluation Report

On 3/22/22 at 1:19 pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA was greeted by caregiver and LPA explained the purpose of the visit. Administrator Jamesha Boyd arrived at 1:45pm and met with LPA, who explained the purpose of the visit.

LPA Bilger 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. Facility is a 4 bed facility with a current census of 4. All residents are ambulatory. 3 bedrooms are upstairs, 1 bedroom is downstairs. There is 1 bathroom upstairs and 1 bathroom downstairs. Staircase has non-slid markings on each step. All toxins and sharp objects are secured. There is an accessible emergency exit through the garage. Activities were being conducted safely in living room upon LPAs arrival LPA also conducted the infection control domain tool.

The facility submitted a LIC 808 mitigation plan , which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Seven staff files were reviewed which contained criminal record clearance and updated first aid/CPR, and COVID-19 vaccination status.

Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 72*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was fully charged. Facility has an emergency food and water kit.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Jamesha Boyd and a copy of this report was given to Jamesha.