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25 | Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with Administrator and explained the purpose of the visit. Administrator holds current certification #6020350735 and expires on 10/17/2024. The facility is licensed to serve four (4) non-ambulatory clients of which two may be bedridden.
LPA toured the facility with Administrator. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room, pantry and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 109.8 degrees Fahrenheit. Food supply is adequate for two day perishable and seven day nonperishable.
Fire extinguishers last inspected on 4/21/2023. Fire drill was conducted on 11/15/2023. Smoke and carbon monoxide detectors are in compliance with fire safety. First aid kit was checked and is complete. LPA observed centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents.
LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed two resident and four staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility.
LPA requested updated copies of the following documents to be submitted via email to LPA by December 13, 2023: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, LIC 610-D Emergency Disaster Plan, Copy of Administrator Certificate, and Current Surety Bond
ruth.wallace@dss.ca.gov
Per California Code of Regulations, Title 22, no deficiencies observed during this visit. Exit interview was conducted with administrator. A copy of this report and LIC 811 (Confidential Names) was left at the facility. |