Facility Evaluation Report

Licensing Program Analysts (LPAs) Michael Tea, Rose Ruppert and Licensing Program Manager (LPM) Alisa Ortiz conducted an unannounced visit for the Required One-Year Inspection. LPA Ruppert explained the purpose of today’s visit and was greeted and granted entry by Jeremiah Smith. LPAs and LPM met with Administrator Marisa Hernandez.

For today’s visit, LPAs observed a total of three of four clients in care and two staff members on duty.

LPAs observed the Administrator's Certificate which expires on March 31, 2025 . LPA Tea observed the PUB475 “See Something Say Something” poster was located and posted in the den and was not the required 20" X 26" size.

LPA Tea and LPM Ortiz toured the interior and exterior portions of the facility with caregiver Jeremiah. The facility is a one level structure and is licensed for four ambulatory client s.

There are a total of four client bedrooms, of which all are private client rooms,and one private room for staff. LPA Tea and LPM Ortiz toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detectors and auditory exit alarms were tested and operational. There are a total of three restrooms of which one is for staff and two are for clients. Restrooms were observed to be missing handrails in both client showers. Toilets were operational, and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 116 - 119 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were located in hallway and were observed to be locked and inaccessible to clients in care. Fire extinguishers were charged, mounted and located in the hallway and kitchen.

LPAs and LPM observed the emergency disaster and evacuation plan, which is posted in the den. Facility had back-up emergency food and water supply, located in the hallway closet. LPA Tea observed that the First Aid Kit had all the required components. LPA Tea observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPA Tea observed patio furniture under shading, and the grounds were free of any hazards. There are two gates in the backyard, which both were self-closing and self-latching. No bodies of water were observed.

For today's visit two Type A deficiencies, a technical violation and technical assistance citations were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Marisa Hernandez. A copy of this report was provided and explained.