Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility staff Ignedio Chavez, Continual Administrator's Certification for Patrick Binarao expires 02/05/2024. There are currently 4 clients living in this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, common areas, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. First Aid kit is on site and complete. LPA Hurt confirmed staff present is background cleared.

LPA Hurt observed two dressers in resident rooms to have broken drawers. LPA Hurt observed the facility resident bathroom door to be broken, rusted, and rotting near the bottom door frame. LPA Hurt observed the bathroom fan to make a very loud sound. LPA Hurt observed a cabinet located in the facility kitchen labeled "staff" to be unlocked and accessible to residents. LPA Hurt observed Tylenol, and cough medicine inside the unlocked cabinet. LPA Hurt observed a refrigerator in the facility garage labeled "staff refrigerator" that did contain items used to cook for facility residents. LPA Hurt observed the refrigerator to have food in containers with no date or label. LPA Hurt observed "antacid liquid" medication inside the refrigerator. LPA observed linen storage area in hallway with no doors, and a sheet covering in place of doors.

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 facility staff Ignedio Chavez and copy of report left at facility