Facility Evaluation Report

On 11/9/21 at 9:28am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Loretta Livingston-Anthony and 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 adult residential facility with a current census of 4. Facility has 4 bedrooms and 3 bathrooms. Each resident has a private room. One private room has its own bathroom. No obstructions to fire exits. LPA also conducted the infection control domain tool.

The facility has an approved COVID Mitigation plan LIC 808 form in place. 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. 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.

Water temperature reads 109.7*F in the bathroom and room temperature reads 71*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 checked 6/1/21. Facility has an emergency food and water kit.

Per California Code of Regulations, Title 22, deficiencies were observed during this visit and noted on LIC 809D. An exit interview was held with Loretta Livingston-Anthony and a copy of this report was given to Administrator Loretta Livingston-Anthony.