Facility Evaluation Report

On today's date, Licensing Program Analysts (LPAs) Rosie Quiroz and Michael Tea conducted an unannounced Annual Required-1 year inspection visit. LPAs were granted entry by Directive Service Professional (DSP) DSP Florendo Caraoa. LPA Quiroz called Administrator (AD) Alvin Mendoza to inform him about LPA's unannounced visit. AD Mendoza not able to attend today's visit due to planned appointment.

AD Alvin Mendoza reported being on premises more than 20 hours per week. AD Certificate for Alvin Mendoza expires on 9/17/2024.

This is a leveI 4C Facility licensed for a capacity of four clients, (4) Ambulatory clients providing services to Adult clients with Developmental Disabilities ages 18-59. At 11:23am, LPA Quiroz reviewed whether the following is in compliance: licensee is operating the facility within the conditions and limitations, which are specified on the license, including the capacity limitation.

The facility is a 1 story home. The home consists of: 4 private bedrooms, 2 restrooms for clients and staff , living room, kitchen with dining area, activity room, two car garage and back yard with chairs and table but no shaded area for clients in care. (SEE LIC 809-D)

Between 11:07am-11:50am, LPAs reviewed 3 of 4 staff records, 4 of 4 client records and 4 of 4 Personal & Incidental funds records (P&I). Staff records, clients records and P&I funds were found to be within Title 22 California Code of Regulations (CCR).

At 1:46pm, LPAs along with DSP Caraoa conducted the tour inspection. A tour of the interior and exterior of the facility and physical plant were inspected, including but not limited to testing hot water temperature in client and common bathrooms. The client's bathroom water tested and measured between 75.2-111.5 degrees Fahrenheit. DSP indicated "Hot water doesn't work." This was verified with DSP 1. (SEE LIC 809-D) All smoke detectors, carbon monoxide, were operational and functional.

At 2:46pm, LPA Tea reviewed 3 of 4 client centrally stored medication records. LPAs observed medications are secured in a secured cabinet in activity room area, not accessible to clients in care. 3 of 4 Medication records were found to be within Title 22 CCR. (SEE LIC 9102 TV) CONTINUED ON LIC 809-C PAGE...