Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted an Annual/Required visit by using the Compliance And Regulatory Enforcement (CARE) Tools on 7/11/2023 but due to time restrains and LPA Wong has returned on today's date 7/14/23 to finish the remaining three (3) domains. LPA met with House Manager Estrella Barrera who allowed entry into the facility and assisted with the visit.

On today's date, LPA inspected the three (3) domains include: Personnel Record-Training, Health Related Services and Disaster Preparedness.

1. Personnel Record-Training: All the staff files are stored and maintained in the facility staff office. All the staff are over 18 years old and they are all associated with the facility with criminal record clearance. The administrator is Martin Sy and his administrator certificate was already expired on 09/20/22 but it shown the application is pending now from CCL website but facility does have a back up administrator and her name is Estrella Barrera and the administrator certificate will be expired on 08/24/2024. The administrator did not have an updated HIV and TB training.

2. Health Related Services: The medication is centrally stored and locked in the medication cart in the storage room near the entrance. LPA inspected all four (4) clients medication and they are all updated and accurate. LPA also inspected the first aid kits and they all have required supplies in the kit.

3. Disaster Preparedness: The facility has an updated Emergency Disaster Plan (LIC610D) and its updated on 7/12/23 with emergency contact number s and at least 2 temporary shelter relocation sites.

On today's visit, LPA interviewed one(1) staff and one (1) client and the others were not able to interview due to their unavailability.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 1

Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the House Manager Estrella Barrara