Facility Evaluation Report

On 06/15/25, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA met with Direct Support Professionals, Matt Lopez and Matt Foster, introduced self and explained reason for visit. Administrator, Aaron Gallegos was contact via telephone and arrived some time later. House Manager, Jose Lopez arrived a short time later. A tour of the facility was completed inside and out. Facility is a 4 bedroom, and 1 bathroom house. There are four private bedrooms, Currently, there are four residents in care. A health and safety check was completed on residents in care. 3 of 4 residents present during todays visit.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 03/19/2026. Last fire drill on conducted on 06/01/2026. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. No deficiencies cited during todays visit.

LPA requested the following documents to be submitted to CCL by 6/19/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), and a current copy of liability/surety insurance in order to update the facility file.

Exit interview was conducted with Administrator, Aaron. A copy of this report was discussed and provided to Administrator.