Facility Evaluation Report

On 12/01/2025 at 8:26 am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Ericka Jimenez and the purpose of today’s visit was explained. The facility is licensed to operate for (72) ambulatory, (2) non-ambulatory,18 through 59 years of age. Currently the home has (57) clients. The clients are (1) Harbor Regional Center/ Social Security) residents. None the clients have Restricted Health Care Conditions and none are utilizing postura l supports or protective devices.

The facility has a current administrator certificate (7008900735) for Ericka Jimenez valid 03/27/2024 - 03/26/2026. The facility fees balance is at $0. The liability insurance is current and valid from 03/04/2026 - 03/04/2026 with Preferred Professional Insurance Company (NAIC #36234) - policy # MFP-02645-25-00.

The facility is a two story building located in a residential neighborhood. The property consists of the following: 16 apartments (3 bedrooms each with 1 resident who has their own individual room and 2 clients to each room for room 2 and room 3) a living room with chairs and or couches. The common areas include a staff office, kitchen with a dining room and pantry room (with 4 refrigerators and can goods), attached gara ge, 2 laundry rooms( with washer, dryer and extra linen), a recreational room and an outdoor shaded area.

Between the hours of 9:22 am - 10:30 am, LPA conducted a records review of (6) client records, (6) staff records, (5) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. At 9:22am, LPA reviewed (6) Client Medication Administration Records and did not observed any discrepancies at the time of visit.