Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA was allowed entry by Samuel Anciado and informed the designated responsible party Evelyn Aciado arrived shortly after. LPA discussed the purpose of today's visit and the inspection. The facility is licensed to serve six (6) clients, ages 18-59, ambulatory only. 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 current. Hazardous items are locked and inaccessible to clients. Fire extinguisher is fully charged, dated 6/24/25. 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 105.9 (bathroom) and 106.8(kitchen) deg F. No pools or large bodies of water at the facility.

Deficiencies were observed on todays’ visit and noted in the 809D. An exit interview was conducted. Report was discussed and provided to the Caregiver Evelyn Anciado.