Routine inspection·November 10, 2021

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms and a staff bedroom--each with a private half bathroom--and a shower room, kitchen, living, and dining rooms. There is an enclosed patio and backyard. There is a 1 car garage, where washer and dryer are located. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 3 residents present, and 3 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Terry Illastron is a certified RCFE administrator (x 12/21) that oversees facility operations. The following updated forms/information are requested to be submitted to CCLD BY 11/24/21: • LIC 308 Designation of Administrative Responsibility • Current lease agreement • Current liability insurance • LIC 999 Facility Sketch (including room dimensions) • LIC 500 Personnel Report • LIC 309 Administrative Organization • LIC 610 Emergency Disaster Plan Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. See Technical Advisory Notes for additional information.