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25 | Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with direct care staff and explained the purpose of the visit. Licensee was notified and showed up at facility shortly after LPA arrived. Administrator certification expires on 4.6.2025.
LPA Wallace and direct care staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility has 3 bedrooms and 2 bathrooms for resident use. There is a formal dining area and additional dining area off the kitchen. The facility has an approved COVID Mitigation plan LIC 808 form in place.
The hot water temperature was observed in resident bathroom at 110.9 degrees Fahrenheit which is between 105*F and 120*F requirement. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire Drill last conducted on 11.22.2023. Fire extinguisher was last inspected on 9.25.2023. Facility has an emergency food and water kit. First aid kit was complete.
LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed four resident and three 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, 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.
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