Facility Evaluation Report

At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Xia Heping. Licensee, Willie Yang, arrived to the facility at approximately 9:40AM. Administrator, Agnes Dizon, arrived to facility at approximately 10:00AM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance for 2 ambulatory and 2 non-ambulatory clients with a total capacity for 4 Clients. Upon arrival, LPA was informed that there were 4 clients in care, and all four clients were out of the community attending Day Program.

At approximately 9:50AM, LPA 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 9:55AM, LPA conducted a walk-though of the facility with Licensee. LPA 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 two story building with 4 Client bedrooms, 3 staff rooms, 3 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. 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 10:30AM, LPA reviewed staff and client files, client medication, and P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. P&I monies were documented, secure and not commingled. Medication was observed to be centrally stored and secure. Administrator's Certificate for Agnes Dizon (6026680735) was current with an expiration date of 06/25/2025.

Fire extinguishers were last inspected October 2023. Smoke detectors and carbon monoxide detectors were tested and operational. The last facility fire/disaster drill was conducted in December 2023.