Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Post-Licensing inspection to this facility, and was greeted by Licensee Armelle Gby. LPA/licensee reviewed PIN 22-07, 22-09, 22-13, 22-15, 22-16 and 22-18. There are 4 clients at the facility. PIN sign up: ccldpolicynotification@dss.ca.gov Licensee agreed to submit Infection Control Plan (LIC 9282) by June 30, 2022.

LPA arrived at the facility and was screened by Licensee. LPA observed that facility has posters on the front door indicating visitors about updated visitor's policy to protect residents in care. Once inside the facility, LPA observed that staff were wearing masks during this visit. At approximate 1:30pm LPA learned through interviews with Licensee that individual (I1) had been working providing care and supervision to clients in care for one day. Per Licensee, I1 has not been associated to the facility yet, LPA informed Licensee that individual (I1) is fingerprint, but they are not associated to the facility and should never be working and providing care to client s prior to a criminal record clearance or exemption. Required posters were observed including (Resident's rights, Emergency plan/numbers, CCLD complaint poster, and visitor policy).

LPA/Licensee toured the facility, it was found to be clean, good repair and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 11/2021 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational. Hot water temperature measured 127.4 and 130.6 degrees F which is not within Title 22 acceptable regulation of 105 to 120 degrees F in 2 out of 2 client’s bathrooms while touring facility on 6/21/22 at 3:00PM. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. Facility records reviewed, staff have CPR, 1st Aid certifications and vaccination records which includes 100% vaccination rate for clients and staff. LPA reviewed 4 out of 4 client files and observed current medical assessments, admission agreements, need/services plans and appraisals. P&I's are kept locked and are not co-mingled.