Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator, Jose Valdez, Continual Administrator's Certification expires 05/04/2025. There are currently 4 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 113 degrees. Toxins and cleaning supplies are locked and inaccessible. LPA Hurt reviewed 3 client, and 3 staff files. LPA Hurt confirmed all staff present is background cleared.

LPA Hurt observed facility client bathroom trash with no lid. LPA Hurt observed facility first aid kit is not complete. LPA Hurt observed the facility Infection Control plan needs to be on correct form. LPA Hurt emailed Administrator the current correct Infection Control Plan form LIC 9282. LPA Hurt advised LIC form 610D Emergency Disaster Plan should be more detailed.

LPA Hurt provided several Technical Advisories.

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-D the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Administrator, Jose Valdez and copy of report left at facility