Facility Evaluation Report
On 4/14/2022 around 9:15am, Licensing Program Analyst (LPA) Mai Thao arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator Laura Hase and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask.
LPA and Administrator toured the facility together to ensure health and safety of residents in care. During today's inspection, Licensee Paul Hase, Administrator Laura Hase, and 3 clients are at the facility. Due to COVID-19, 3 clients are only attending Day Porgram once a week for outside activities and volunteering. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, two (2) bathrooms, kitchen, dining area, storage areas, and laundry room. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and the administrator completed the infection control domain and facility was found to be in substantial compliance at this time.
During today's inspection, LPA and Administrator also reviewed 3 of 3 client's P&I Cash. Around 9:40am, LPA and Administrator observed that the facility has a Sun Room added to the facility that is not on the facility sketch. LPA advised Licensee and Administrator on making alteration to the facility (CCR 80086) LIC forms that are needed. Licensee and Administrator stated that the alteration started in November 2021 and was completed in December 2021. Licensee and Administrator provided LPA with a copy of permits during the inspection. LPA requested for Licensee and Administrator to fax a copy of LIC 200 and floor plans to Licensing by close of business (COB) today.
No deficiencies are being cited as a result of todays inspection.
Exit interview conducted and copy of report was left at the facility with Licensee and Administrator.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction