Facility Evaluation Report, 08/18/2023

At approximately 9:30AM, Licensing Program Analysts (LPAs) Felias and Coppo arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Henry Mattos. Assistant Program Director, John Ahrens, arrived at approximately 10:15AM. Facility is an Adult Residential Home that provides care and assistance for Adults with Mental Health Diagnoses. Facility has an approved fire clearance and capacity for 8 Ambulatory Clients. Upon arrival, LPAs were informed there were currently 2 staff members on site.

At approximately 9:45AM, LPAs reviewed the Facility's Staff Roster. During review, LPAs discovered that Staff Member 1 (S1) was fingerprint cleared, but not associated to the facility as required. (See LIC9102, Technical Violation, Regulation 80019(e)). LPAs contacted the Regional Office and confirmed the fingerprint clearance and association status of S1. Facility provided LPAs with the association paperwork for S1, today, 08/18/2023. LPA confirmed with the Regional Office that the paperwork had been received.

**Assistant Program Director understands that a Civil Penalty is not being issued today for S1 because their association paperwork has been received by the Regional Office to be processed.**

At approximately 10:50AM, LPAs conducted a walk-though of the facility with Assistant Program Director. LPAs observed the following: The facility was found to be at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a single floor building, with 4 client bedrooms, 3 client bathrooms, a staff bedroom/bathroom, 2 office spaces, a kitchen, dining room, living room, and laundry/recreation area. Facility has a mitigation plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. 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 Fahrenheit.

During walk-through LPAs observed that facility's Fire extinguishers were last inspected March 2022 (This Deficiency has been cited, see LIC809D, Regulation 80020(a)).