Facility Evaluation Report

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA was greeted by Lillie King, Caregiver S1. LPA met with Derek King, Administrator (AD).

LPA and S1, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas.

LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 106.9 degrees in residents bathroom with the AD which is in required range of 105 to 120 degrees. LPA observed the residents' shower did not have non-skid mats.

Last Fire Drill conduced dated 9/17/21. Fire extinguisher maintained 02/17/21.

Fire alarm and carbon monoxide functional.

LPA and AD observed centrally stored medications and complete First Aid Kit.

LPA reviewed 5 staff and 4 resident files. Resident files complete.

Administrator Certificate valid until 8/30/2022.

All persons in facility fully vaccinated. LPA observed 30 days PPE supply.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with AD and a copy of report given via email.