Facility Evaluation Report

Licensing Program Analysts (LPAs), Alviso and Florio, conducted a Required- 1 Year visit, on 4/23/24 at approximately 11:15pm, and met with Administrator/Licensee Catherine (Cathy) Clark. Currently there are four (4) residents in care.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for one(1) resident. Facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for five (5) non-ambulatory, which includes two (2) bedridden, effective 10/30/23. Bedridden clearance is for #3 only.

LPAs reviewed resident records, four (4) of four (4).

LPAs reviewed five (5) staff files. All staff have criminal record clearance as required. All staff have First Aid and CPR certification as required. All staff have required training.

LPAs toured the facility with the Administrator. All exits were free and clear of obstruction. Fire extinguisher was serviced and charged, as required. Facility has smoke alarms, which are also carbon monoxide detectors, in each bedroom, hallway, and common area, except in the kitchen. Hot water was checked at 119.1 degrees Fahrenheit, which is within regulation. Facility had a sufficient supply of food. Facility had required 72 hour shelter in place food, water, and other emergency supplies on hand. Facility had sufficient supply of hygiene products, cleaners/disinfectants, and paper supplies. Facility had sufficient supply of linens, towels, and furnishings for resident use. All bathrooms had grab bars, and non-slip surface/non-skid mats for resident use. Facility had sufficient lighting in all common areas, bedrooms, bathrooms, and hallways