Facility Evaluation Report

On 1-18-22 at 11:35am, LPA Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Shalimer Goulding 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 facility with a current census of 6. This facility has 5 bedrooms and 2 bathrooms. 2 bedrooms are dedicated for staff and storage use. There is a dining area off the kitchen and a formal living/TV room. No obstructions to fire exits noted. 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. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and backyard. 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 118.4*F in the bathroom and room temperature reads 73*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 4/5/21. Facility has an emergency food and water kit. All staff records reviewed. Staff1 (S1), S2, S3, S4, S5, and S6 have current first aid and CPR certifications. COVID-19 vaccinations are current for all staff with exemptions for S1, S3, S4 and S6.

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