Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace arrived at this facility unannounced to conduct an Required 1 - Year Annual Inspection Visit. LPA met with the administrator and explained the purpose of the visit.

LPA Wallace and administrator 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 adult residential facility with a current census of 5. There is a hole in ceiling of staff room #2. Facility has a living room/tv room and dining area off the kitchen. There is a locked shed in the backyard not accessible to residents in care. No obstructions to fire exits noted. There are 5 rooms for clients in care. LPA also conducted the infection control domain tool.

The facility submitted a LIC 808 mitigation plan, which was approved. 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 back yard. 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 113.2*F in the kitchen sink 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 checked 2/7/2022. Facility has an emergency food and water kit.

Facility is conducting quarterly fire drills, last one conducted 8/20/2022. LPA observed mitigation plan completed. First aid kit observed to be complete. Emergency Disaster Plan completed on 08/31/2021.

LPA reviewed 3 of 5 resident records. LPA reviewed 4 staff records and all have health screen and TB results. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed current first aid certificates and are current.

One deficiency was observed and cited from the California Code of Regulations, Title 22.

Exit interview conducted with administrator. A copy of reports and appeal rights given to administrator.