Facility Evaluation Report

Licensing Program Analysts (LPAs) Jessica Cho and Sean Haddad arrived unannounced for the purpose to conduct the Required 1-Year Annual Inspection. LPAs were greeted and granted entry after stating the purpose of the visit to Assistant Administrator (AA) Marife Dumlao. Administrator (Admin) Leilani Alejandro arrived on site to assist with the inspection.

LPAs conducted a tour of the indoor/outdoor area of the facility accompanied by the Admin and AA. The following was observed: This is a single story facility comprised of four bedrooms and three bathrooms. LPAs observed two additional bedrooms and one additional bathroom inside the facility and are pending clearance. There is a backyard with a patio cover for shading. LPAs observed one client and one staff present at the facility. The three client bedrooms are spacious and easily accommodates the clients' furnishings. Furniture for each client bedrooms were inspected. LPAs inspected the staff bedroom as well. The bathrooms were clean, faucets, and toilets were operational. The hot water temperature reading was initially measured at 132 .0 and 142.0 degrees Fahrenheit and was readjusted/corrected during the visit which then measured at 119.0 and 117.0 degrees Fahrenheit for two out of the two client bathrooms. There was sufficient supply of clean linens. LPAs observed a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Carbon monoxide, smoke detectors, fire extinguisher were tested and in operating condition. LPAs observed medications were centrally stored and secured. Facility's licensing fees are paid. LPAs reviewed the three client files and two staff files, interviewed one client and one staff. LPAs inspected the funds and ledgers for the three clients.

Based on the observations made during today’s inspection, a deficiency is being cited per the Title 22 Division 6 of the California Code of Regulations. See LIC809D.

An exit interview was conducted and a copy of this report and appeal rights were discussed with and provided to Administrator Leilani Alejandro and Assistant Administrator Marife Dumlao.