Facility Evaluation Report

On 6/18/2025 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Program Manager, Erika Montejano explained reason for visit and was permitted entry into the facility. Clients not present at time of visit. LPA completed a tour of the facility inside and out. Facility currently has 9 non-ambulatory clients.

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 4/14/2025. Activity rooms observed to have the required furnishings and with adequate lighting. Sharps and medications were located in locked cabinets.

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), 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, Erika. A copy of this report was discussed and provided to Program Manager.