Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced 1 Year Annual Inspection visit. LPA met with the Administrator Christopher Walters and explained the purpose of the visit. Administrator Certificate expires 11/28/23.

LPA Wallace inspected the physical plant including but not limited to the kitchen, dining room, 4 resident bedrooms; 2 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. Dining area leads off from the kitchen area. LPA also conducted the infection control domain tool.

Facility has submitted a COVID-19 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.

There is a locked storage for medications and toxins. Food supply is adequate for two day perishable and seven day non-perishable. Water temperature registered at 107.2*F in the kitchen sink and room temperature reads 73*F. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. Fire alarms were checked and found to be in working order. Fire Extinguishers expire 12/21/23. LPA observed an adequate amount of linens and found the first aid kit to be complete.

LPA reviewed 3 of 3 resident records and 4 staff records. LPA reviewed medications of 3 residents comparing with Centrally Stored Medication Record and physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed and have current first aid certificates. All health screen and TB results are current for staff..

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and report and appeal rights were given to Administrator.