Facility Evaluation Report

On 05/27/26 at 1:05PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. ADM has a current administrator certificate # 7003375735 which expires 03/25/2028.

At 1:20PM, LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in storage cabinets. Comfortable temperature is maintained at 69 deg F. Hot water temperature was measured at 119 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 3 staff and 5 client files. P & I monies matched clients' records. Fire & Earthquake drills are conducted monthly. Fire extinguisher was observed fully charged and purchased on 12/11/25.

Updated copies of the following documents were obtained from facility:

· LIC500- Personnel Report / Client Roster (LIC9020)

· LIC308- Designation of Facility Responsibility

· LIC610D- Emergency/Disaster Plan including infection control plans

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.