Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with the Back up Administrator Roldan Tungol. At approximately 11:40 am, with the assistance of staff, LPA took a tour of the physical plant. The smoke alarms and carbon monoxide are functional. The fire extinguisher is located in the kitchen with expiration date 1/4/24. This is a 5-bedroom, 3- bathroom one story adult residential facility. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for clients' use. One(1) bedroom designated for staff use. All four (4) bedrooms, in use by clients, were properly furnished with appropriate beddings and linens with sufficient lighting . Bathrooms: There are two (2) bathrooms designated for clients' use. All two (2) bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 105.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas : These included the living room and dining area. The common areas were properly furnished and have sufficient lighting. Surrounding Grounds : Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located in staff room. No detergents or laundry hazardous supplies were present in the laundry area. Clients Files : LPA conducted a file review of clients records to insure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications : Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.