Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual required visit and was greeted by a staff member. Staff contacted the Administrator, Valeree Zepeda and informed her LPA was at the facility. LPA met with the administrator shortly after and explained the reason for the visit. The facility is licensed for four ambulatory of which two may be non-ambulatory clients.

LPA Rios with the assistance of the Administrator conducted a physical plant tour of and observed the following.

The facility is licensed for a capacity of four (4) clients. The fire clearance is approved for four (4) clients, 2 ambulatory clients in rooms labeled #1, #2, and non-ambulatory clients in rooms #3. Room #3 can be shared. LPA reviewed the approved Fire Safety Inspection (STD 850) dated 04/29/2006 and the facility sketch. LPA observed a discrepancy with the room designations and the facility sketch. The current designation of rooms does not present a health and safety issue because all clients are ambulatory. LPA will reach out to the Fire Inspector and follow up with the facility.

At entry LPA observed the living room, dining table with chairs, a couch and television. In the living room LPA observed required postings on a bulletin board. The dining table sits the capacity of the facility and is in good repair. In the kitchen LPA observed there to be a sufficient supply of two-day perishable and seven-day non-perishable foods in the facility. The facility has an overflow of food stored in a second refrigerator and freezer in the garage. Food storage and preparation areas are clean and inaccessible to pests. The fire extinguisher is located in the kitchen with purchased date 02/18/2026. Sharps were observed locked in a tool box in a kitchen cabinet. (Continue to LIC809-C)