Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 1/7/25. LPA met with Administrator, Floresita Lim, and explained the purpose for the visit. The facility is licensed to serve (6) developmentally disabled adults, ages 18 through 59, of which (4) may be non-ambulatory.

LPA used the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility. The following were observed:

The facility is a single story home consisting of 3 shared client bedrooms, 1 administrator's office, 1 staff room, 2 bathrooms, living room, open dining and kitchen, family room, and an attached garage. The spacious outdoor has a shaded patio with seating, exercise equipment, and gardening. Each client bedroom has the appropriate furnishings and storage space. Bathrooms are clean. There is a carbon monoxide detector located in the living room and smoke detectors throughout the home. There is no swimming pool on the premises. There are no items obstructing the walkways. Knives and cleaning products are locked. There was sufficient food supplies for both perishable and non-perishable. The water temperature was measured at 131.5 degrees F, which is over the required range.

LPA reviewed all 5 client files. The files contain all the required documents such as medical assessment with TB test results, admission agreement, consent forms, and safeguards for property/valuables and cash resources. P&I ledgers were also reviewed for all clients. Medications are centrally stored in the administrator's office and they are being administered as prescribed by the physician. There is currently one client with a restricted health condition and plan outlines what staff is responsible for. LPA selected 4 staff files to review. The administrator's certificate expires on 8/21/25 and the HIV & TB certificate was issued on 6/4/23. CPR & First Aid certificates are current. Staff are receiving on-going training.

Facility has the updated Emergency and Disaster Plan, however, there were no emergency drills conducted quarterly. LPA issued a technical violation for lack of drills.

A deficiency is issued on the LIC809D form. An exit interview was held and a copy of this report along with appeal rights were given to the administrator.