Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with the direct care staff and explained the purpose of the visit.

LPA and direct care staff inspected the physical plant including but not limited kitchen, dining room, living room, three resident bedrooms, garage and grounds of the facility to ensure compliance with Title 22 regulations. The facility is a single story structure with three double occupancy rooms for residents and a live in staff bedroom. The facility was observed to be sanitary and free of odor. The facility was equipped with adequate furniture and lighting for the six clients. No obstructions to fire exits noted. Facility has a separate living room and family room with dining area off the kitchen.

The facility submitted a LIC 808 mitigation plan, which was approved. Water temperature reads 109.8*F in the kitchen sink which meets the 105-120 degree Fahrenheit regulation. 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 extinguishers were last inspected on March 9, 2023. Facility has an emergency food and water kit.

LPA reviewed three staff and three resident files that were locked and readily available for review. Staff had current First Aid/CPR certificates All staff have criminal record clearance and are associated to the facility.

LPA received the following updated documents on today's date: LIC 308 Designation of Responsibility, administrator certificate, and copy of surety bond.

Per the California Code of Regulations, Title 22 no deficiencies were observed or cited.

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