Facility Evaluation Report

At approximately 12:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Staff Member, Steven Pozzi. Assistant Program Director, John Ahrens, arrived later during visit at approximately 1:30PM. 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, LPA were informed there were 7 Clients in care with 1 client out of the community and 1 staff member on-site.

At approximately 12:25PM, LPA reviewed staff files, client files, client medications, and P&I monies. Staff and Client files were found to be organized and thorough. During Review, LPA observed that 1 of 7 client files did not have a Medical Assessment and that 6 of 7 client files did not have a Functional Capabilities Assessment (See Technical Violations, Regulation 80069(b) and Regulation 85068.2(b)(1)(F) ). Staff have current First Aid/CPR certifications. Client Medications were centrally stored and secure. P&I Monies were found to be documented, secure and not commingled.

LPA is requesting the following documents to update the facility file:

Affidavit regarding Client/Resident Cash Resources (LIC400)

Designation of Facility Responsibility (LIC308)

Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Saturday, 10/14/2023.

Exit interview conducted. Copy of report, LIC9102 (Technical Advisory/Violation), discussed and provided to Assistant Program Director. Signature on form confirms receipt of documents.