Facility Evaluation Report

On 7/16/2025, Licensing Program Analyst (LPA) J. Duarte conducted an unannounced Annual Required Inspection. LPA arrived and was greeted by (AD) Jessica Delgadillo Pattee.

The facility currently has two residents in care. One resident was home watching television and the other resident was at a day program.

LPA toured the inside and outside of the facility with the AD. The facility was observed to be clean and odor free. The temperature was at 72 degrees F. The residents’ rooms were observed to have the required accommodations. The resident restrooms fixtures were observed to be operational. Water temperature in the hallway restroom measured at 116.9 degrees F. The water to the second restroom towards the back of the residence measured at 114.6 degrees F. The kitchen was toured. The facility was observed to have a seven day supply of non-perishable food. LPA did not observe a minimum of two days supply of fresh perishable foods . Facility has two container of emergency food supply stored in the dining room. The sharps, First Aid Kit, and medications were observed to be locked and secured in a locked hallway closet. Medications and MARS were reviewed for both residents. The living room and dining room had adequate seating for residents. All chemicals and detergents were observed to be locked and secured in a cabinet in the garage. Extra linens are stored in bins in the garage as well.

The outside of the facility was toured; exits were open and free of obstruction. There is back patio with a table and chairs.

Smoke detectors and carbon monoxide detectors were present and observed to be operational. A Fire extinguisher was located in the dining-room with a service date of 03/27/2025. The last fire drill was conducted on 06/11/2025 according to facility records.

LPA requested the following documents to be submitted to CCL by 07/23/2025: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached LIC 809D.

Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights was discussed and provided to Administrator, whose signature on this form confirms receipt of this document.