Facility Evaluation Report

On 1/16/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit. LPA met with the Administrator, Ashley Acosta and explained the purpose of today’s visit. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. The facility is licensed approved for (6) ambulatory developmentally disabled clients (age 18-59). The census is currently 3.

Acosta Family Home III is a one-story structure located in a residential neighborhood. The facility consists of (4) bedrooms, (3) bathrooms, living room, kitchen, dining area and a laundry room and attached garage. Facility maintains all required posting throughout the facility.

LPA conducted a records review of (3) client records, (6) staff records, and (3) client medications. All client & staff records were complete. LPA Shirley and Ashley walked throughout the facility and all common areas such as the living room and dining room were all observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked . Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature was adjusted to meet state requirement between 105 – 120 F.

LPA observed that there is ample seating and space for all clients. All walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. Smoke/ Carbon Monoxide detectors were operable. The last fire/emergency drill was conducted on 12/6/25. There is (1) charged fire extinguisher. Exterior areas are clean and clear of obstructions and hazards and there are no bodies of water present. The client’s P&I records were not available for review.

Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, Divisions 6 chapter 1, see LIC 809D.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Ashley Acosta.