Routine inspection·October 24, 2022

License Program Analyst (LPA) Farhaan Sarangi arrived unannounced to conduct a Required – 1 year inspection at Wayne Home. LPA was welcomed by Facility Manager, Danica Ednalaga and was granted access into the facility. Administrator arrived 10 minutes later. LPA began touring the facility with the House Manager and Administrator. LPA observed the hallway and passageways leading to exits were free of obstruction and facility temperature was comfortable. Hot water temperature measured 116.7 degrees F. and 116.7 degrees F. within range of 105 degrees and 120 degrees F in bathroom faucets accessible to residents. Smoke and carbon monoxide detectors were tested and found to be operational during the inspection. Fire extinguishers last serviced/charged on July 2022 were mounted in the hallway and laundry room. Toxins were stored locked under the kitchen sink and in the laundry room. Sharp knives were observed to be locked in a kitchen drawer which is inaccessible to residents in care. Toilet and shower areas were clean and sanitary. Resident’s requiring special feeding supplies have designated closets or cabinets where their supplies are stored separately. Ample supply of hygiene products were stored in a cabinet in the garage. Perishable and non-perishable food supply met the minimum requirements for current census. Refrigerator and freezers were clean and food was stored properly. Medications centrally stored and locked in a cabinet located in the living room. Small locked refrigerator is used for medications requiring refrigeration located in the garage. First Aid kit was inspected and found to be appropriate during the inspection. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE supply stored in the garage. Facility has been N95 Fit tested on March 2022. (Report continued on LIC 809C) LPA requested the following documents to be sent: LIC 500- Personnel Report LIC 308- Designation of Responsibility LIC 309- Administrative Organization LIC 400- Affidavit regarding Client Cash Resources Updated facility sketch Updated Emergency Disaster Plan (LIC 610D) Surety Bond Most up-to-date Liability insurance Control of Property Register of residents No deficiencies were observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.