Facility Evaluation Report

At approximately 12:15PM, Licensing Program Analysts (LPAs) Felias and Magdaleno arrived unannounced to conduct a Required 1 Year visit. Administrator, Agnes Dizon , arrived to the facility at approximately 1:00PM. 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, LPAs were informed that there were 4 clients in care with all four clients out of the facility attending Day Program.

At approximately 1:05PM, LPAs conducted a walk-though of the facility with Administrator. LPAs observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 5 Client bedrooms, 2 bathrooms, and common areas. Facility has an Infection Control plan on file. 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. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Trash cans with lids were available to 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. At approximately 1:20PM, LPAs reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation

At approximately 1:30PM, LPAs reviewed staff files, client files and client medication. Client P&I monies are managed by Newleaf and bank statements were reviewed. All files were found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Administrator's Certificate for Agnes Dizon (6026680735) was current with an expiration date of 06/24/2025.

Fire extinguishers were last inspected October 2024. Smoke detectors and carbon monoxide detectors were tested and operational. The last facility fire/disaster drill was conducted in February 2025.