Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee Honesto Fernandez, Continual Administrator's Certification expires 03/30/2023 There are currently 5 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA confirmed all staff present is background cleared.

LPA Hurt observed the carpet in two resident bedrooms to be extremely dirty. LPA observed two dressers holding up a TV in the living area, and one dresser missing a drawer. LPA Hurt observed the bathroom vanity mirror to be broken and falling. Upon entry to the facility LPA Hurt observed the temperature on thermostat to be 58 degrees. LPA observed the fire extinguisher has not been serviced within the year, last serviced 05/2021.LPA Hurt observed several food containers, and Ziploc bags with raw frozen fish inside the refrigerator with no label or date.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610 the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Licensee Honesto Fernandez, and a copy of report along with appeals rights left at facility