Facility Evaluation Report

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Administrator Samira Menendez and explained the reason for the visit. The facility is licensed to serve 4 ambulatory clients only in the age range of 18 through 59.

A tour of the single-story facility included: 3 client bedrooms, 2 bathrooms, kitchen, dining area, living room, laundry area, attached garage, front yard, and backyard. LPA Mora conducted the tour with Samira Menendez and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps were observed locked in a closet near the kitchen. Chemical and cleaning solutions are kept locked under the kitchen sink. The First Aid kit is kept locked in a file cabinet located in the living room and it is fully stocked with all required items including a current manual. There are clean towels and extra linen in the laundry area. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in a cabinet located in the living room. All bedrooms have all required furniture, lighting, and bedding. The 2 bathrooms were observed with shower mats. The water temperature was tested and measured at 119.7 degrees F, which is within the required 105-120 degrees F. A fire extinguisher was observed in the kitchen and is fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. A carbon monoxide was observed in the kitchen and was operable during the visit. The front yard and backyard are clean. There is a shaded seating area in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. LPA reviewed medication for 3 clients. The fourth client has been at a skilled nursing facility since 02/28/2024. Medications are documented properly and given as prescribed. Four client and five staff files were reviewed. LPA observed administrator certificate for Samira Menendez – 6014412735 with an expiration date of 07/26/2024. LPA interviewed 2 staff and 1 client.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.