Facility Evaluation Report

01/23/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Jenna Baluyot and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, garage, backyard, shed, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured at 117.5 F. LPA observed two (2) fire extinguishers, fire detectors, and carbon monoxide detectors.

LPA observed two of the four bed rooms to not have a bed. LPA observed two of the four residents to not have clothing in their room or a place to store such items. LPA observed no personal items or furnishings in one bedroom. LPA observed a hospital bed with bed rails in one of the four bedrooms with no medical order for the postural supports. LPA was told by the administrator that two of the four residents sleep in the common area of the home.

LPA reviewed a total of four (4) residents' files and five (5) staff files, which contained all the required documentation.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code.

An exit interview was conducted, and Plans of Corrections were reviewed and developed collaboratively. A

copy of this report, LIC 809-D, and Appeal Rights were discussed and provided .