Facility Evaluation Report

Licensing Program Analysts (LPA's) Ruth Wallace and Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA's were met by Administrator and explained the purpose of the visit. LPA's were screened upon entry for COVID precautions. Administrator Certificate Expires 8/23/2024. The facility conducts routine symptom screening for employees, residents, and visitors. LPA's observed the facility to have hand washing stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a COVID -19 room/bathroom if needed. Common touch surfaces are cleaned after each use.

LPA's and administrator toured the physical plant including but not limited to the kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the care home to ensure compliance with Title 22 regulations. Facility is a 3 bed facility with a current census of 3. The entry door leads to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. LPA's also conducted the infection control domain tool. The hot water temperature was measured using the facilities thermometer to be 113.0*F which is within the required range of 105-120*F. Medication and toxins were locked. LPA's observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings.

The facility submitted a LIC 808 mitigation plan , which was reviewed and attached to the facility profile. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was serviced on 3/9/22 and is in compliance. Facility has an emergency food and water supply in a separate storage area in kitchen.

A review of (3) facility resident records was conducted and have all required documents for Community Care Licensing (CCL). A review of (2) facility personnel records was conducted. All staff is fingerprint cleared and associated to the facility. All staff have current First Aid certifications on file. Facility is conducting initial and continuing training as required.

Per California Code of Regulations, Title 22, no deficiencies observed during this visit. Exit interview was held with Administrator and a report was given at conclusion of visit.