Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator, Katherine Toledo Continual Administrator's Certification expired on 11/20/2022 and has been submitted for renewal. 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. 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 and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

LPA Hurt observed the facility dryer being used as storage, and the residents clothing being hung to dry on clothing lines in garage area. LPA Hurt observed the facility bedrooms are not being used as labeled on facility sketch submitted to Licensing.LPA Hurt measured the water temperature in the bathroom near the back sliding glass door at 122 degrees. LPA Hurt observed a large dog aggressively barking, and growling inside a kennel near the kitchen area.

There following deficiencies were 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 Katherine Toledo and copy of report left at facility