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 Rhona Amado (Assistant Administrator) and explained the reason for the visit. The facility is licensed to serve 4 ambulatory only developmentally disabled clients ages 18-59 years old. Facility is operating within the scope of its license.

A tour of the single-story facility included the living room, dining area, kitchen, 2 client bedrooms, 1 staff room, 2 bathrooms, attached garage, front yard, and backyard. LPA Mora conducted the tour with Rhona Amado 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 the medication cabinet. Chemical and cleaning solutions are kept locked under the kitchen sink. Medications are kept locked in a kitchen cabinet. The First Aid kit is kept locked in the medication cabinet and it is fully stocked with all required items including a current manual. Clean towels and extra linen were observed in a hallway cabinet. Dining and living room have sufficient lighting and sitting area. All bedrooms have all required furniture, lighting, and bedding. Both bathrooms were observed with shower mats. The water temperature was tested in both bathrooms and measured at 105.7 degrees F and 106.6 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 hallway and was operable during the visit. The front yard and backyard are clean. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. LPA reviewed medication for all 3 clients. Only 1 client does not have any medication prescribed. Medications are documented properly and given as prescribed. LPA reviewed 4 client files and 3 staff files. LPA observed Jay Samilin administrator certificate - 6017369735 with an expiration date of 06/02/2024. Proof of renewal prior to expiration date was provided to the LPA and CDSS administrator certificate status website shows that it has been renewed effective 06/03/2024. Administrator is still waiting for the new administrator certificate.

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