Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown and Dana Garcia, Associate Governmental Program Analyst (AGPA) arrived unannounced on a subsequent complaint visit on 10/5/22 at 10:00AM.

The team met with Georgia Wilcomb and stated the purpose of todays visit. The facility is licensed for a capacity of 15 residents. The team requested copies of the Official Pest Prevention Inc. invoices to include description of what type of service was provided. LPA received a copy of the Account Statement Report for dates 1/1/22 - 12/31/22 which indicated the invoice amounts and balances not the specific work that was performed. LPA observed an invoice that indicated that the facility sprayed for bed bugs on 5/24/22. The team and Administrator Georgia Wilcomb toured residents room and observed bed bugs on residents mattress on top of the bed bug covering under the sheets during this visit. The team also observed the Administrator has several "sticky traps" in the kitchen under the cabinets that contained many roaches and there was used cat food cans present in the front of the facility. The team observed that the staff in the facility was not wearing masks as mandated for infection control due to covid-19 pandemic.

Based on observations the preponderance of evidence standards has been met; therefore, the above deficiencies will be cited during this visit.

Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, deficiencies are being cited on the attached 809D. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided.