Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with House Manager Excalibur Holder, 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, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. 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 confirmed staff present has a COVID 19 vaccine card or exemption on file.

LPA Hurt observed the facility staff room unlocked, and several chemicals were in the bathroom accessible to residents. LPA Hurt observed the metal window screen for window located inside the kitchen to be bent and not covering entire window. LPA Hurt observed a "make shift" office between garage and kitchen not listed on facility sketch. LPA Hurt observed the facility water to be hotter than 120 degrees.

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-E 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 House Manager Excalibur Holder and copy of report left at facility