Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Lena Reinholds and explained the reason for the visit.

At approximately 10:15 am, with the assistance of Administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke detectors and carbon monoxide detectors were tested and observed to be operational. The fire extinguisher is located in the living area. The charge date August 16, 2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked cabinet under the kitchen sink. Bedrooms: There were four (4) bedrooms designated for clients' use. Two (2) bedrooms are designated for private use, and one (1) room is shared. All four bedrooms, in use by clients, were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are two (2) bathrooms designated for clients' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 110.7 and 114.6 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas : These included the living room and dining area. The common areas were properly furnished. Properly labeled medications were locked in one of the dining cabinets.

Surrounding Grounds : Entry/exits were free of obstruction. There was furniture appropriate for outdoor

use. The outdoor area was free of hazards. Laundry Room/ Garage: LPA observed the laundry room located in the garage. The Garage is attached to the facility and currently being used for extra storage, an extra refrigerator, and freezer. There were no chemicals/hazardous items located in the garage. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications : Medication and Medication Records were review for proper documentation. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.