Facility Evaluation Report

On 6/18/2025 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Case Manager, Robert Perez explained reason for visit and was permitted entry into the facility. Program Manager, Kelly Wheeler arrived some time later arrived a short time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on clients in care.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors function on a system. Carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced on 1/28/2025. Last fire drill on conducted on 4/17/2025. Activity rooms observed to have the required furnishings and with adequate lighting. Sharps and medications were located in locked cabinets. LPA observed sufficient seating under covered patio areas.

The following issues were observed during today’s visit: Left side gate observed with a lock not approved on the fire clearance for a locked perimeter. 2 of 5 files reviewed had outdated IPP's.

Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct and potential risk to the health, safety and/or personal rights of residents in care.

LPA requested the following documents to be submitted to CCL by 7/4/2025: 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) in order to update the facility file.

Exit interview was conducted with Program Manager, Kelly. A copy of this report, deficiencies, and appeal rights were discussed and provided to Program Manager. A plan of correction was developed by Administrator and reviewed by LPA.