Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced 1 Year Required Annual Inspection visit. LPA met with the administrator and explained the purpose of the visit. Administrator Certificate Expires 03/12/2024

LPA Wallace and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Resident bathroom flooring needs to be replaced, due to tears in flooring and patio screen door needs to be replaced. LPA also conducted the infection control domain tool. The hot water measured 107.4*F which is within the required range of 105-120*F. LPA observed the facility to have adequate food supply. Smoke and carbon detectors were in good repair. Fire extinguisher expires 3/30/2023.

The facility submitted a LIC 808 mitigation plan , which has been approved. Upon entry LPA observed screening for COVID precautions including temperature check. Upon entry LPA observed the facility to have COVID - 19 informational, and social distancing signs posted throughout the facility, and on the front door. 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.

Per California Code of Regulations, Title 22, Division 6 deficiencies were cited during this visit.

Exit interview was held and a copies of reports were given to Administrator. Appeal rights were given to Administrator.