Facility Evaluation Report

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by Administrator, Mysti Medina to complete this annual visit.

The residence was set at 71 degrees F temperature and free of passageway obstructions inside and outside. LPA observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 110.8 degrees F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medications are kept lock in the hallway closet. Knives and sharps are locked in the kitchen area. Cleaning supplies and PPE are stored and locked in the office. Smoke detectors and carbon monoxide are dual detectors, they were checked and operating. Last drill was completed on 11/07/23. Fire extinguisher was last service on 12/14/2022. There was outdoor seating for clients.

During the visit a file review was conducted for residents and staff. An exit interview was conducted, and a copy of this report was provided to the Administrator, Mysti Medina whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 12/18/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage, Administrator’s certificate