Facility Evaluation Report

Licensing Program Analyst (LPA) Nancy Guillen conducted an unannounced visit for the purpose of completing an annual required inspection. LPA was greeted and granted entry into the facility after explaining the reason for the visit. Administrator (AD) Lauren Lu was notified via telephone and later arrived to assist with the inspection. LPA observed Administrator certificate is current with an expiration date of November 18, 2026. This is an Adult Residential Facility licensed for four ambulatory clients of which one may be non-ambulatory. Currently four clients reside at the facility. LPA observed three clients present at the time of visit and was notified that one client is currently residing at a Skilled Nursing facility.

LPA began the tour of the inside and outside of the facility and observed the following:

This is a one story facility with four client bedrooms, three bathrooms, a living room, dining room, family room, kitchen, and an attached garage. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in the garage. LPA observed knives and sharps to be stored in a locked kitchen cabinet. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The facility is maintained at a comfortable temperature. LPA observed that medication is centrally stored in a locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care; however during medication review it was observed Banophen was administered to Resident 1 (R1) without medication being available at the facility and was not prescribed to client; a deficiency was cited on today's date.