Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual inspection. LPA met with administrator Victor Mora and explained the reason of the visit. LPA used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures and observed food supply. Facility has submitted a mitigation plan and was approved on 07/01/21.

Currently the facility has no client reside there. The facility is a one story house located at the residential neighborhood. The home consists of kitchen, living room, dining area, three clients' bedrooms, two and half bathrooms, staff bedroom, back pantry/storage room and a detached garage. The front and back yard are well maintained and the back yard has a shaded area and sitting area. The 1st bedroom has one bed, one closet, one dresser, required linen and furniture and sufficient lighting. The 2nd and 3rd bedroom has two beds, two dresser, required linen and furniture and sufficient closet space and lighting. All toilets, hand washing and bath tub/shower are safe, sanitary and in good operation condition. All sharp knifes and cleaning supplies were locked. LPA inspected the smoke detector and carbon monoxide and they are operable and in compliance. The hot water measured in the two bathrooms are between 118 and 120 degree F. LPA also observed food supply is adequate and probably stored. All the cleaning solution and toxic are stored and locked in the pantry. Due to no client currently reside in the facility, there's no medication to be reviewed during the annual inspection.

No deficiencies issued under California Code of Regulations of Regulations Title 22.

Exit interview conducted. A copy of the report was provided to Administrator Victor Mora.