Facility Evaluation Report

On 2/14/21 at 12:34pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the lead caregiver and explained the purpose of the visit. Administrator Thelma Dougherty arrived at 1:15pm.

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 6 bed facility with a current census of 6. Facility has 4 bedrooms, 2 bathrooms. There is a formal dining room and covered patio leading out to the backyard. LPA also conducted the infection control domain tool.

The facility submitted a LIC 808 mitigation plan. 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.

Water temperature reads 131.3*F in the bathroom and room temperature reads 69*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 11/1/2021. Facility has an emergency food and water kit. No obstructions to fire exits noted. All sharps and toxins are secured. LPA reviewed 5 staff charts. All first aid and COVID-19 vaccination cards are current.

Per California Code of Regulations, Title 22, deficiencies were observed during this visit. Exit interview was held with Thelma Dougherty and a copy of this report was given to Thelma. Appeal rights provided