Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted a unannounced Required 1 year Inspection Visit. LPA met with Administrator and explained the purpose of visit. Administrator's Certificate expires 2/15/2025.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. LPA observed sufficient furniture and lighting throughout 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 109.4 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 extinguishers last inspected on 8/9/23. 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. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 1/15/2024.

LPA reviewed four resident files and four 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.

All In-Service Training has been completed each month which includes: Fire Drills Procedure, Facility Sketch Review and Discussion, Emergency and Disaster Drills, and Review Emergency Shut Off and Locations.

Department of Social Services Survey Binder includes: Annual Inspection, LIC 610-D Emergency Disaster Plan, LIC 308 - Designation of Administrator, LIC 309 - Administrative Organization, LIC 500 - Personnel Report, Personal Rights, Activities for each Client, Description of facility and schedule, Stipulation Posted, 911 Calling Policy, Emergency Procedures, and Incident Reporting.

LPA received the following updated documents for community care licensing on today's date: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, LIC 610-D, Copy of Administrator's Certificate, and Copy of Liability Insurance.

Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed or cited today.

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