Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Program Coordinator, Kaylyn Pasikala. There are currently 15 clients participating in this day program. LPA inspected the interior and the exterior of the facility including main activity areas, bathrooms, kitchen, and offices.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The facility has a carbon monoxide detector. The facility is performing disaster drills as required. Water temperature was tested at 113 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. The facility has current updated Emergency Disaster Plan and Infection Control Plan, and a Plan of Operation. LPA reviewed 4 staff, and 4 resident files.

LPA observed the facility bathroom vents are very dusty, the facility baseboards are also dusty.

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

LPA 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 Program Coordinator, Kaylyn Pasikala and copy of report left at facility