Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Mary, administrator and discussed the purpose of today's visit and the inspection. The facility is licensed to serve six (6) clients, ages 18-59, ambulatory only. Annual fees are current. Administrator certificate was current with expiration date on 9/16/25.

For today's annual inspection,CARE tool was used, physical plant was conducted, food supply/staff files/ clients' files were reviewed, staff/clients interviews were conducted, and medications were reviewed. The facility was a single story home located in a residential neighborhood, consists of three (3) clients’ bedrooms, one (1) full client bathroom, 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 maintained the required two (2) days perishable and seven (7) days non- perishable. Clients’ bedrooms had the required furniture and in compliance. Adequate linen and personal hygiene supply were observed. 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 119.5 degree F. No pools or large bodies of water at the facility.

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 administrator, whose signature on this form confirm receipt of these documents.