Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and explained the purpose of the visit.

LPA 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 six Social Rehabilitation Facility with a current census of five. Facility has 6 bedrooms, 3 bathrooms. There is a dining area off the kitchen and a formal living room for residents. Common touch surfaces are cleaned after each use. All sharp objects, toxins, and other dangerous items are inaccessible to residents in care. Fire drill last conducted on 1/1/2024.

LPA measured the hot water temperature in resident's bathroom at 110.9 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed sufficient seven day non-perishable and two day perishable food supplies. 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 extinguisher was last inspected 1/31/2024. Facility has an emergency food and water kit.

LPA reviewed five residents and five staff charts. All contents including first aid certifications, and fingerprint clearances in place. All sharp objects, toxins, and other dangerous items are inaccessible to residents in care.

LPA requested the following updated documents via email to community care licensing by February 15, 2024: LIC 308 Designation of Administrator, LIC 500 Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Administrator. A report and LIC 811(Confidential Names) was left at facility.