Facility Evaluation Report

At approximately 2:10PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with House Manager, Makela Moore. Facility is an Adult Residential Home that provides care and assistance for Adults with Developmental Disabilities. Facility has an approved fire clearance and capacity for 6 Ambulatory Clients. Upon arrival, LPA was informed there were currently 6 clients in care and 1 staff member on site. LPA was also informed that all clients were out of the community attending Day Program.

At approximately 2:25PM, LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. At approximately 2:30PM, LPA conducted a walk-though of the facility with House Manager and observed the following: Facility is a 3 story building with 4 client bedrooms, 4 1/2 client bathrooms, a staff room and office space, and common spaces. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a 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. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for client use. LPA also observed that facility does not have an evacuation chair as required. (See LIC9102, Technical Advisory, HS&C 1565(f)(1)). Hot water temperatures for 1 of 5 sinks in facility were found to be out of compliance with Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's half bath sink measured at 100.5F (this deficiency has been cited, see LIC809D, Regulation 80088(e)(1)). Facility's fire extinguishers were last inspected December 2023. Facility's last fire drill was conducted December 2023.

LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date.

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, LIC9102 (Technical Advisory), and Appeal Rights discussed and provided to House Manager. Signature on form confirms receipt of documents.