Facility Evaluation Report

Licensing Program Analysts (LPAs) Stefanie Mutialu and Jill Nakagawa arrived unannounced to conduct an inspection of the facility and found 6 residents in care. There were 2 care staff on site. Licensee arrived 15 minutes later.

LPAs inspected the facility and found 5 of 6 residents socializing in the living room and watching television. The rooms were clean and had appropriate bedding . Kitchen was clean and had ample supply of perishable and nonperishable food, as required per Title 22. During inspection LPAs observed an unlocked shed with potential hazards inside, including pesticides, paint, sharp tools. Also, LPAs observed an unsecured can of disinfectant, over-the-counter medications and an inhaler during the inspection of bathrooms. LPAs provided facility with Regulation 87309(a) and 87705(f)(2).

Deficiency/ies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted with facility Licensee, whose signature on this document confirms receipt.