Facility Evaluation Report

At approximately 1:00PM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Staff Members, Terry Keady and Steve Pozzi, and Team Leader, Sean Mansfield. Assistant Program Director, Suhay Rivas, arrived during visit at approximately 1:45PM. 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 Clients where 1 client can be Non-Ambulatory. Per fire clearance, the Non-Ambulatory room is located in the bedroom closest to the recreation room. Upon arrival, LPA was informed there were 8 clients in care and 3 staff members on site.

LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA finished review of staff files and client files. All files were well organized and contained the required documentation. LPA reviewed 2 client medications. During medication review, LPA observed that all routine medications were appropriately centrally stored, but "as needed" medications or PRNs were not centrally stored as required (deficiency cited, regulation 80075(k))

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Team Leader and Assistant Program Director. Signature on form confirms receipt of documents.