Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required one year annual inspection visit. LPA met with direct care staff and explained the purpose of the visit.

LPA Wallace and direct care staff 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 four bed facility with a current census of zero. Facility has three bedrooms. one bedroom has a private bathroom. Dining area is shared with kitchen space. The facility submitted a LIC 808 mitigation plan , which was approved. The facility has a designated infection control lead.

Water temperature reads 110.6*F in the bathroom and room temperature reads 75*F. 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 last inspected on March 8, 2023. 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 and a report was given to direct care staff.