Facility Evaluation Report

LPA Noel Wolf Petersen made an unannounced visit to conduct an annual/required inspection. LPA Wolf Petersen met with Administrator, Will Turner and explained the reason for the visit. Census: 12

LPA Wolf Petersen & Will Turner inspected/toured the facility. LPA observed the interior, and the exterior of the facility were inspected including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins, LPA asked lockable storage to remain locked while not in use. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA gave guidance that stored foods outside of their original container should be dated. Smoke alarms were checked and found in good working order. Carbon Monoxide detector was found in good working order. All residents are ambulatory. LPA checked medications and found medications are being dispensed as ordered. LPA gave guidance that the start date of medication blisters should be added to the spine of the blisters.

LPA reviewed a 5 residents and 4 staff records and 1 administrator record. Resident files were found to be complete and current A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates, health screenings for TB, and fingerprint clearance. Facility is conducted staff training as required.

2 clients interviewed, 1 staff interviewed. LPA asked for a lic 500 and lic 9020 to be sent to the LPA: noel.wolfpetersen@dss.ca.gov

No deficiencies were observed at the time of the visit. Exit Interview and report left with the administrator.