Facility Evaluation Report

On 11/07/23, Licensing Program Analysts (LPA's) Renee Campbell and Ruth Wallace arrived unannounced to conduct a case management visit at approximately 1:30 PM based on a prior annual visit.

LPA Campbell was let in by Resident 1 (R1) and observed the f acility live-in caregiver, Staff 1 (S1) on the couch. Administrator, Maria Denton arrived 15 minutes later. The medicine cabinet was observed by LPA Campbell unlocked and the key was left in the cabinet lock. S1 was notified of the unlocked cabinet, it was locked up immediately and S1 removed the key. LPA Campbell walked through the facility and observed that the resident’s toilet was clear of urine stains and the bathroom floor had been mopped. Cleaning products were locked in the bottom cabinet with an intact lock. The dining room table and chandelier had been dusted. LPA will continue to follow up with this facility and its designated Administrator in regard to these issues.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiency are being cited on the attached 809-D during this visit.

If the cited deficiency is not corrected by the noted due dates; civil penalties may be assessed. The Facility Designee was provided a copy of their rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of the report was given.