Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with direct care staff and explained purpose of visit. Administrator certificate expires 4/11/2024

LPA and direct care staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in kitchen sink at 111.4 degrees Fahrenheit which is within the required range of 105 to 120 degrees.

Fire extinguishers last inspected on 8/11/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to clients. LPA reviewed and compared client medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 12/16/2023.

LPA reviewed three client files and three staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

The following documents will be submitted via email to LPA Wallace by 1/18/2024:

LIC 308 Designation of Administrative Responsibility, Administrator Certificates, and Proof of Current Surety Bond.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit.

Exit interview held with direct care staff. A copy of report and LIC 811 (Confidential Names) were left at facility.