Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA Flores met with Renorman Pascual - Residential Counselor and explained the reason for the visit.

The facility is licensed to serve developmentally disabled clients ages 18 thru 59. Ambulatory only. The single story home is located in a residential neighborhood. Consist of 4 client bedrooms, 1 staff bedroom, 2 bathrooms, a laundry area, a kitchen, dining, room, a living room, a detached garage, a backyard, and a front yard.

LPA Flores toured the facility with Renorman Pascual and observed the following:

Facility is good repair inside and outside. No large bodies of water were observed. Backyard has a shaded sitting area. Each client bedroom has sufficient lighting, furniture and bedding required. Smoke/carbon monoxide detectors were tested and in working condition. Bathrooms were observed to be in working condition, water temperature was tested in bathroom #1 at 110.0 degrees F. and bathroom #2 tested at 116.7 degrees F., which is within the required 105-120 degrees F. Kitchen was observe clean and in good repair. Sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Cleaning supplies were observed locked under the sink and knives and sharps were observed locked in a utility box. Medication cart was observed lock in the living room. Living room and dining were observed clean and in good repair. Fire extinguishers were observed and last inspected on 8/3/22. Last fire drill was conducted on 5/3/23. Emergency disaster plan was observed (LIC610D 10/03) which is not the latest version. LPA reviewed medication for 6 clients and P&I money. LPA reviewed files for 5 clients and 5 staff. Administrator certificate was observed for Segundino Gotladera #6008122735 exp. date: 9/4/23, HIV/TB training was missing in administrator's file.

Deficiency was noted on LIC 809D. Exit interview was conducted with Damion Lee Residential Director and a copy of this report was provided.