Facility Evaluation Report

At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 year visit and met with Staff Member, Hugo Vega-Interiano. Program Director, Adrian Fuentes, arrived during visit at approximately 9:55AM. Facility is a Short Term Social Rehabilitation home that provides care and assistance to Adults with Mental Health diagnoses. Facility has an approved fire clearance and capacity for 6 Ambulatory Clients. Upon arrival, LPA was informed that there were currently 5 Clients in care and 3 staff members 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. LPA reviewed staff and client files, and client medications. Facility does not manage P&I monies for clients. Staff Files were all found to be well organized, thorough and contained the required documentation. During client file review, LPA observed that 3 of 5 clients did not have a negative TB test on file (deficiency cited, see LIC809D, regulation 81069(f)(1)). Medication was centrally stored and secure.

LPA requested the following documents to update facility file:

Designation of Facility Responsibility (LIC 308)

Updated Emergency Disaster Plan (LIC 610D)

Documents to update facility file to be submitted to Community Care Licensing (CCL) by due date of 10/12/2024.

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

Exit interview conducted. Copy of report, LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Program Director. Signature on form confirms receipt of documents.