Facility Evaluation Report
On 09/16/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA was greeted by Staff Member (SM), Vanscott Smith and explained the purpose of this visit. LPA Pascua asked SM Smith go call the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. Shortly after, LPA Pascua met with FDA Kenroy Anderson and explained the purpose of the visit.
This facility is licensed to serve 6 residents of which all may be non-ambulatory. This facility has a hospice waiver for 4 and a dementia plan on file.
Current census is 6. A brief interview with Kenroy Anderson was conducted.
LPA reviewed 3 resident files and 2 staff files. 1 out 3 resident files did not have a complete Pre-Appraisal form. 2 out of 3 resident files were current and up to date. 2 out of 2 staff files were current and up to date.
The Facility Designated Administrator has a current administrator certificate #6062116740 and expires on 1/2/2024.
A tour of the facility was conducted. The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 02/27/2023.
The kitchen area was toured. LPAs observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional food supplies were identified in the garage. LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.
A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.
A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction