Facility Evaluation Report

On 10/06/23 at 8:00 AM, Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with staff, Sandeep Kaur.

LPA tour the inside and outside of the facility. The facility was observed to be at a comfortable temperature of 74 degrees F, clean, in good repair, and no passageway obstructions. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies and chemicals are stored and locked in a cabinet outside the garage. Sharps and medications are kept in a locked cabinet in the living room. All bedrooms were observed to have required furnishings and with adequate lightening. LPA observed four bedrooms. Bathroom is properly equipped, and the hot water temperature was tested at 105.58 degrees F. Carbon monoxide and smoke detectors were tested and observed to be operational. A sample of staff and client’s files were reviewed. First Aid checked and fully stocked.

1. Fence is broken in the backyard. Side gate needs to be fixed. Side of the home need to be free of debris.

A deficiency is being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D.

The following updated forms are to be submitted to CCL by 10/20/23:

LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, LIC999, Administrator certificate, and control of property.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with staff. A copy of this report and appeal rights were discussed and left with staff, Sandeep Kaur whose signature on this form confirms receipt of these documents.