Facility Evaluation Report

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit on this day for the purpose of conducting a Required - 1 Year inspection. LPA was greeted and allowed entry by staff. Administrator (AD) Asuncion "Sonia" Jacinto arrived shortly after. LPA confirmed that Administrator has a current Administrator certificate, which expires on 08/19/2024. Licensee Anil Suresh arrived shortly after.

The facility is a level 4H home with four clients in care, of which two were present during today's visit. The home is a single story home with 4 client bedrooms, 2 bathrooms, kitchen, dining room and sun room.

LPA toured the interior and exterior of the facility and observed the following but not limited to: walkways and hallways were free of clutter and or debris. Two days perishables and seven days non-perishables were observed. Kitchen was inspected for proper sanitation and cleanliness. Smoke alarms were observed operational. Client bedrooms were observed to have required furnishings including but not limited to: bed, night stand, chair and lamp. Adequate lighting was observed throughout the home. Sharps and toxins were observed inaccessible. Linen and hygiene supplies were stocked. Medication was observed centrally stored and locked inaccessible. The home was observed to be maintained at a comfortable temperature. Hot water temperature in client bathrooms was observed to be 110 degrees F. Fire drills are conducted quarterly, last conducted on 03/22/2023.

LPA reviewed four of four client files and observed the following but not limited to: Physician Report, Admission Agreements, Individual Program Plans, TB tests and Emergency Identification forms. LPA reviewed client medications and medications appeared to be being given as prescribed. LPA reviewed client Personal and Incidental (P&I) monies and observed the following: P&I appears to match P&I log. LPA reviewed two staff files and observed the following but not limited to: Criminal Record Clearance, Criminal Record Statement, TB test and First Aid/CPR

Based off the observations made, the facility appears to be in compliance with Title 22 Division 6. An exit interview was conducted and a copy of this report, confidential names list will be sent to email on file.