Senior Care Records.

Facility Evaluation Report

Momentum Work, INC. Lakeside, Santa Maria11/22/2021Licence 425850008

Capacity4
Census4
Date signed11/23/2021 10:11:32 AM
The inspector’s account

On 11/22/21 at 9:35 AM, Licensing Program Analyst (LPA) Toan Luong arrived at the facility and performed a facility risk assessment with facility staff. LPA conducted an unannounced on-site One Year Infectious Control Annual visit to the facility. LPA met with Director of Residential Services Pam Holcombe and Administrator Edward Maldonado and explained the purpose of the visit.

Director took LPA on a physical plant tour of the facility. The facility has submitted a mitigation plan to the department.

The facility is an Adult Residential. During the facility tour LPA observed Covid-19 signs posted throughout the facility, but CDSS PINs were not posted. LPA advise having PINs readily accessible to residents, visitors, and staff. Administrator posted CDSS PINs prior to LPA's departure. LPA advised facility to fit-test staff. Facility is awaiting test kits from company department.

LPA reviewed the Annual Mitigation Inspection Control Tool Module. Module was addressed with director to satisfaction.

Exit interview was conducted. No deficiencies cited and report emailed to director.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction