Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with the administrator and explained the purpose of the visit.

LPA and administrator inspected the physical plant including but not limited kitchen, dining room, living room, eight resident bedrooms, one staff room, garage and grounds of the facility to ensure compliance with Title 22 regulations. The facility was observed to be sanitary and free of odor. The facility was equipped with adequate furniture and lighting for the eleven clients. No obstructions to fire exits noted.

The facility submitted a LIC 808 mitigation plan, which was approved. Water temperature reads 111.7*F in the kitchen sink which meets the 105-120 degree Fahrenheit regulation. and room temperature reads 75*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were last inspected on June 31, 2023. Facility has an emergency food and water kit.

LPA reviewed three staff and three resident files that were locked and readily available for review. Staff had current First Aid/CPR certificates All staff have criminal record clearance and are associated to the facility.

LPA received the following updated document on today's date: Administrator certificate

Per the California Code of Regulations, Title 22 no deficiencies were observed or cited.

Exit interview held with administrator. A report and LIC 811 (Confidential Names) was left at the facility