Facility Evaluation Report

At approximately 2:05PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Abraham Gebru. House Manager, Ronald Berliner, arrived to the facility at approximately 2:53PM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance for 6 Ambulatory Clients. Upon arrival, LPA was informed that there were 6 clients in care, and all six clients were out of the Facility attending Day Program. LPA was also informed that there one staff member on-site.

At approximately 2:20PM, LPA reviewed 6 Client Medication Records and P&I Monies. 5 of 6 Medication records were observed to be centrally stored and secure. 1 of 6 Client Medication Records was found to not have a discontinued order for one medication and it has not been administered to the client for at least 3 months. Per Per Title 22 Regulation, there is to be written instructions from a Physician in the event a medication is discontinued as well as a medical re-evaluation conducted for the client (See Technical Advisory 80075(b)(5)(A ). Client P&I monies were documented, secure and not commingled.

At approximately 2:55PM, LPA reviewed a sample size of 3 Staff Files. Review of Staff Files indicated that staff had First Aid and CPR certification.

LPA observed that the facility does not have a evacuation chair at this time. Facility does have an operable lift. House Manager understands that an evacuation lift needs to be on-site to remain compliant with Health and Safety Code (See Technical Advisory 1565(f)(1) .

Exit interview conducted. Copy of report and LIC9102 (Technical Advisories) discussed and provided to Program Director. Signature on form confirms receipt of documents.