Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 03/10/2023 at 9:07 am. LPA was met by Staff S1 and explained the purpose of the visit. Facility is licensed to residents 18 to 59 years old. The facility has a fire clearance approved for ten (10) ambulatory. There are seven (7) level 3 developmentally disabled clients residing at this facility. Residents at this facility are receiving services from Frank D Lanterman Regional Center. LPA requested and obtained a copy of Personnel Report (LIC 500), and Resident Roster (LIC 9020).

LPA OBSERVATIONS: Tour began at 10:02 am and was led Staff S1. The Facility is a two-story building located in a residential area with five (5) client shared bedrooms, two (2) client shared bathrooms, two (2) living rooms, kitchen, dining room, front yard, backyard and two (2) detached car garage.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Kitchen sink water temperature was measured at 110.3 degrees F. At 10:10 am, LPA observed knives and sharps located in kitchen cabinet to the left of sink, to be accessible to 7 out of 7 clients in care. Several bottles of disinfectants and cleaning solutions were observed near washer and dryer and were accessible to 7 out of 7 clients in care.

· Dining Room/Living room: Dining room was observed to be clean and contained one table and 7 chairs. Living room was observed to contain 1 couch, 2 recliners TV and plenty of lighting. Thermostat located near living room was observed at 74 degrees F.