Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Program Director Beth Chudy. There are currently 50 clients receiving services at this location LPA inspected the interior and the exterior of the facility including the common spaces, activity rooms, kitchen, transportation and outdoor areas.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 111 degrees. First Aid kits do not have all required supplies. Toxins and cleaning supplies locked away and inaccessible to clients. This facility does not provide food service. LPA reviewed Emergency Disaster Plan, Infection Control Plan, 5 resident files, and 5 staff files.

No deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Program Director, Beth Chudy, and copy of report left at facility