Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. Upon arrival, LPA met staff, Evelyn Anciado, who assisted with visit. The facility is licensed to serve six (6) clients, ages 18-59, ambulatory only. LPA discussed with staff regarding the purpose of today's visit and the inspection. Annual fees are current.

During the visit, the following domain of the new inspection tool was used: infection control domain; a tour of the facility was conducted; food supply was reviewed; and medications were reviewed. The facility is a single story home located in a residential neighborhood, consists of three (3) clients’ bedrooms, one (1) full client bathroom, a kitchen, a dining area near the kitchen, a living room with a TV, a medication storage room, a laundry area at the backyard, a front yard, a side yard with a parking patio. Facility maintains the required two (2) days perishable and seven (7) days non- perishable. Clients’ bedrooms have beds, dresser and closet space available. Adequate linen and personal hygiene supply are observed. Lamps/lights for each room are available to ensure the safety and comfort of all persons in the facility. Backyard has a covered trash can. Smoke detectors and carbon monoxide detectors are operable. Medications are centrally stored and locked.

Medications are properly logged and current. Hazardous items are locked and inaccessible to clients. Fire extinguisher is fully charged. Pesticides/poisons are not stored in food areas, kitchen, or where kitchen equipment/utensils are stored. The front yard is well maintained. Water temperature is measured at 115.5 degree F. No pools or large bodies of water at the facility. Passageways are free of obstruction. Administrator certificate is current, expires on 09/16/23.

No deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6. An exit interview was conducted. This report was discussed and provided to staff, whose signature on this form confirm receipt of these documents.