Facility Evaluation Report

On 11-14-22 at 1:56pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with assistant administrator Carrie Mumphrey and explained the purpose of the visit. Administrator William Puckett was notified via phone of LPA's visit and purpose.

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 5-bed facility with a current census of 4. Facility has 4 bedrooms and 3 bathrooms for resident use. There is a formal living room and dining room area off the kitchen. Facility is a two story with all ambulatory residents. 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 as necessary. 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. No obstructions to fire exits noted. All toxins and sharp objects inaccessible to residents in care. Five staff files reviewed. All contents current including first aid/CPR certification, COVID-19 vaccinations, and criminal record clearances.

Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 74*F. LPA observed the facility to have adequate food supply during visit. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and sanitary. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 5-23-22. 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 Carrie Mumphrey.