Routine inspection·August 27, 2021

Licensing Program Analyst (LPA) Anthony Tuck Island arrived to conduct an unannounced annual/random inspection on 08/27/2021. LPA met with Staff Linda Jack and explained the purpose of the visit. Ibifubara Jack is the Administrator and holds certificate #6046173740 that expires on 11/28/2021. This facility is a single story building licensed to serve six (6) non-ambulatory residents at any given time. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (115) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 05/19/2020. Thermostat observed at (78) degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed staff associations. The following forms need updating and submitted to CCLD by 08/30/2021: LIC 308 copy of administrator certificate LIC 500 copy of liability insurance LIC 610 Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were found during today's visit. Exit interview held with Ibifubara Jack and a copy of report given at the conclusion of the visit.