Senior Care Records.

Facility Evaluation Report

Our House, Petaluma03/14/2022Licence 496800742

Capacity11
Census11
Date signed03/14/2022 03:11:01 PM
The inspector’s account

License Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an annual required – 1 yr. Infection Control Inspection of the facility. LPA was welcomed by Licensee Mary King & Assistant Administrator Marina Arpon . There is a total of 11 residents, 6 of which are dementia residents. There are 5 residents currently on Hospice.

Facility tour/inspection began at 1:45 PM:

LPA toured the facility on 3/14/2022 with Assistant Administrator Marina Arpon; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 12/14/2021 at the time of the visit. Facility Smoke and Carbon Monoxide detectors were found to be operational. There are night lights in common areas, resident’s bedrooms, and bathrooms of the facility. Hot water temperature measured between 116.6 degrees F and 116.9 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathroom faucets. Facility has two residents' bathroom with faucets that are motion sensor. The facility serves residents with dementia and has a plan of operation for special care and programming. 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 on this day. There are no special dietary needs for residents currently at the facility. Food is available for residents any time of the day. Toxins are stored in a locked garage room. There was a supply of cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. Resident’s bedrooms have lighting & appropriate furnishing. Medications were centrally stored in a locked medication closet on the hallway by facility office.

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