Facility Evaluation Report

On 7//09/2026 Licensing Program Analyst (LPA) K.Kaur 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 observed in activities and having lunch. LPA completed a tour of the facility inside and out.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. LPA toured Kitchen, several activity rooms and quiet room. Activity rooms observed to have the required furnishings and with adequate lighting. Sharps and medications were located in locked cabinets. Clients bring lunches or buy out. Client cubbies observed in second building. Water temperature tested in bathroom sink in building 1 at 121.5 Degrees, Smoke detectors function on a system tested by fire department on 2/09/2026. Carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced on 4/20/2026. Courtyard observed with benches with umbrellas for shade and recreation.

Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

LPA requested the following documents to be submitted to CCL by 7/16/2026: 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 conducted and a plan of correction was reviewed and developed with Program Manager. A copy of this report and appeal rights were discussed and provided to Administrator, whose signature on this form confirms receipt of this document.