Facility Evaluation Report

Licensing Program Analyst (LPA)s Vaid and Mallett conducted an unannounced annual inspection. The facility is licensed as Adult Residential Facility to serve for ages 18 to 59 years old, four (4) ambulatory clients, of which one (1) maybe non-ambulatory. Client census is two (2). LPA met Staff#1 (S1), Emmaruth Banguguilan-co-administrator-staff in charge, who assisted with the visit. LPAs discussed the purpose of today's visit with Licensee Gemma Rodriguez over the phone.

This annual visit included staff interview with staff, used of CARE inspection tool, physical plant, and food supply/staff records review. Client files and medication were reviewed.

The home was a single family home, located at a residential neighborhood consisted of four (4) client bedrooms, two (2) bathrooms, kitchen, dining area near the kitchen, living room with a TV, laundry room, and backyard with a shaded patio, with adequate seating. The kitchen was clean and is maintained the required two (2) days perishable and seven (7) days non- perishable food available. Clients’ bedrooms/ bathrooms were furnished with required furniture and in compliance. Adequate linen and personal hygiene supply are observed. Smoke detectors and carbon monoxide detectors were operable. Hot water temperature measured 105-120 degrees Fahrenheit. Medication cabinet with locks were located in the kitchen and centrally stored. Hazardous items were locked and inaccessible to clients. Liability Insurance expires 2026. Administrator certificate expires 10/01/2027. Surety bond to to emailed to LPA.

No deficiencies cited per California Code of Regulations, Title 22, Division 6. An exit interview was conducted. This report is discussed and provided to co-administrator Emmaruth Banguguilan.