Facility Evaluation Report

On 9-10-21 at 3:28pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the lead caregiver Eddie Nieves 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 6 bed adult residential facility with a current census of 5. Facility has 4 bedrooms for clients in care. There is a separate living and TV room. A dining area is off of the kitchen. An emergency exit as designated on the facility sketch was inoperable during today's visit due to a broken lock obstructing it from opening. 30-day supply of PPE observed in facility. All toxins and sharp objects are not accessible to clients in care. 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.

Water temperature reads 114.2*F in the bathroom and room temperature reads 77*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 11/3/2020 . Facility has an emergency food and water kit.

Per California Code of Regulations, Title 22, Division 6, deficiencies were observed during this visit as noted on LIC 9099D. An immediate civil penalty of $500 is assessed in addition to the citation issued. Exit interview was held and a report along with appeal rights was given to Lead Caregiver Eddie Nieves