Facility Evaluation Report

At approximately 8:30 AM, Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a Required 1 Year visit and met with House Manager, Ronald Berliner. Administrator, Ian Ramos, arrived later during visit at approximately 9:00AM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance and capacity for 6 ambulatory clients. Upon arrival, LPA was informed that there were 6 clients in care, and all six clients were out of the community attending Day Program. Facility is a two-story building with 6 bedrooms, 3 bathrooms, two staff rooms, and common spaces.

At approximately 8:40 AM, LPA conducted a walk-though of the facility with Administrator & House Manager. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction; although client room 1 was missing window screen and had strong pungent odor, bathroom 2 needs base of shower fixed and tub needs new grout or cleaned (see pic) & bathroom 3 needs electric air vent (no window) fixed as it is not working and has strong urine odor, and base of shower to be fixed/re grouted/replace top of base of shower where one walks in, is broken (see pics) and missing kitchen cabinet door to be replace (see LIC809-D). Facility had emergency lighting. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to clients; although seizors were observed in unlocked kitchen drawer and cleaning supplies bleach (see pics) were in bathroom cabinet under sink accessible to clients in care, and removed immediately by staff (see LIC809-D). There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees F.

At approximately 9:45AM, LPA reviewed the Facility's Staff Roster and found that all staff were background cleared and associated to facility per regulation. LPA reviewed 4 staff files, 5 of 6 client files, client medication, and client P&I monies.. All files were found to be well organized, thorough and contained the required documentation. Continued on LIC809C