Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Administrator, Gemma Rodriguez, and explained the purpose for the visit.

During today's visit, LPA Maldonado conducted a tour of the physical plant with Administrator, observed the facility food supplies, reviewed (6) client medications, (6) client files, (3) staff files, and conducted interviews with (3) staff. LPA attempted to interview (2) clients and was unable to to conduct interviews with (2) other clients due to clients being out of the home at the time of the visit. The facility is a single-story home, operating as an Adult Residential Facility. It is licensed to serve (6) developmentally disabled adults, ages 18-59, which all may be ambulatory, only. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review.

LPA observed (3) client bedrooms and (1) live-in staff bedroom. Client bedrooms had the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms in the home. (1) is designated for staff, (1) designated for clients. Both bathrooms are equipped with a toilet, shower, and wash basin. The hot water was tested and measured between 109*F, which is in compliance. Food supplies was observed and was sufficient as required. Emergency food supplies and water were available. First aid kit and manual were observed- available and complete. No bodies of water were observed on the premises. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to clients in care. The last fire drill was conducted on 01/01/2024. LPA did not observe a carbon monoxide detector in the facility at the time of the visit. Per Administrator, it was taken down due to the walls being painted and was misplaced. (4) client files and (3) staff files were reviewed and observed to be complete with all required documentation. (4) client medications were reviewed and were observed to be documented properly and given as prescribed.

Per California Code of Regulations, Title 22, deficiencies were observed and cited on the LIC809-D page.

An exit interview was conducted and a copy of this report and appeal rights were provided.