Facility Evaluation Report

Licensing Program Analyst (LPA) Miriam Flores arrived unannounced to conduct the Annual inspection. LPA was granted entry by House Manager, Sherry Ross and explain the purpose of the visit. Licensee, Brad Kendall was present during this visit for a few minutes and left. Facility was toured with House Manager, Sherry Ross and Administrator, Senorita Uti.

During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required food supply and paper products. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. First aid kit was checked and contained all required items.

Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was charged and was serviced on 03/11/2023. Emergency disaster drills are conducted quarterly, last drill completed on 12/01/2023. First Aid kit is fully equipped.

Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D.

An exit interview was conducted, and a Plan of Correction was developed with Administrator, Senorita Uti. A copy of this report and Appeal Rights were discussed and left with Administrator whose signature on this form confirms receipt of these documents.

LPA requested the following updated forms faxed to CCLD by 12/29/2023: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage.