Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson arrived at this facility unannounced to conduct an annual inspection visit. LPA met with facility representative Staff and explained the purpose of the visit. The facility is licensed for 6 residents. 4 ambulatory and 2 non-ambulatory. There are currently 3 residents at this facility.

LPA toured the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms; client bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the doors and baseboards were not clean. LPA observed sufficient furniture and equipment in client rooms. LPA observed expired food in the refrigerator and the pantry. The hot water temperature was measured at 109*F which was within the required range of 105-120*F.

LPA observed the centrally stored medications area to be locked and inaccessible to client. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair.

LPA reviewed (3) client files and (2) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

Deficiencies were observed and cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code. Advisories given for staff file and following the weekly menu.

An exit interview was conducted, a copy of this report, LIC 809-D and appeal rights were provided.