Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual /Infection Control visit on this date. LPA met with Rose Imbat, Administrator AD.

LPA and AD, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas.

LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 108.3 degrees in residents bathroom with the AD which is in required range of 105 to 120 degrees.

Last Fire Drill conduced dated 1/30/2022. Fire extinguishers expire 3/10/2022.

Fire alarm and carbon monoxide functional.

LPA and AD observed centrally stored medications.

LPA reviewed 2 staff and resident files. Resident emergency contact complete. LPA observed all staff files complete.

Administrator Certificate expires 03/30/2023.

All persons in facility fully vaccinated. LPA observed resident practicing social distancing. LPA observed 30 days PPE supply.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, NO deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with AD and a copy of report given via email.