1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 3:46 PM to conduct an unannounced annual visit. LPA met with Caregiver Sarah Nate and was granted entry. The Administrator Julita Mendoza was unavailable for the inspection. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) non-ambulatory residents of which 1 may be bedridden. The facility has an approved dementia plan of operation and a hospice waiver for 2 residents.
Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies.
Physical Plant and Environmental Safety: The facility temperature read at 73 degrees. The facility consists of 5 resident bedrooms, and 3 bathrooms, living room, and kitchen. The bedrooms are furnished with tv, lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 111 degrees within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the kitchen and inaccessible to the resident. The facility and has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order.
Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings.
Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, hospice documentation, client rights, and admissions agreements.
(Continued on LIC809-C) |