Facility Evaluation Report

On 11/20/25 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Direct Support Professional, Marcos Banuelos, explained reason for visit and was permitted entry into the facility. Licensee, Administrator and Program Manager arrived some time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. There were 2 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 present and operational at time of visit. Fire extinguisher last serviced on 05/22/2025. Last fire drill conducted on 11/15/2025. Water temperature measured at 112.2 in front bathroom. Resident rooms observed to have the required furnishings and with adequate lighting. LPA observed sufficient seating under covered patio areas.

The following issues were observed during today’s visit: Sliding door in t.v. room was observed to not open and close properly and in need of repair. Hot hair iron and razors were observed unlocked and accessible to residents in care in the office. 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 risk to the health, safety and/or personal rights of residents in care.

LPA requested the following documents to be submitted to CCL by 11/28/2025: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), copy of current liability insurance/surety bond in order to update the facility file.

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