Facility Evaluation Report

At approximately 9:40AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Administrator, Robert Zhai. 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, LPA was informed that there were 4 clients in care with all four clients out of the facility. LPA was also informed that there was one staff member on-site.

At approximately 9:45AM, 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 9:50AM, LPA conducted a walk-though of the facility with Administrator. 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, 2 bathrooms, and common areas. The second floor of the house goes into the garage that clients do not have access to. Per conversation with Administrator, in the event of evacuation, clients leave from exits located on the main floor. 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. 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. Toxins were observed to be stored inaccessible to clients. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for 2 of 3 sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. One sink was found to be at 123.4F (this deficiency has been cited, see LIC809D, Regulation 80088(e)(1)). During walkthrough, LPA observed that client bathrooms do not have trash cans with lids (See technical advisory, LIC9102, Regulation 80088(f)(1)). Per conversation with Administrator, clients need assistance with incontinence care but do not require incontinence supplies such as depends.

At approximately 10:15AM, LPA reviewed staff files, client files, client medication, and client 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. Medication was observed to be centrally stored and secure. P&I monies were documented, secure and not commingled.