Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with house manager and explained the purpose of the visit. Administrator's Certificate expires .

LPA and house manager 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 has 4 bedrooms. 3 bathrooms are occupied by residents, 1 bedroom is occupied by staff. The dining area leads off to the kitchen. There is an emergency exit gate on the right side of the facility.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 112.6 degrees Fahrenheit which is within the required range of 105 to 120 degrees. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility.

Fire extinguisher last inspected on 6/26/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 4/7/2024.

LPA reviewed six resident files and two 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.

LPA requested the following updated documents for community care licensing to be submitted via email by April 10, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, and Copy of Administrator's Certificate. ruth.wallace@dss.ca.gov

Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, see 809-D's for deficiencies observed or cited today. If the deficiencies are not corrected by the noted due date civil penalties may be assessed.

Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.