Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry Staff Lorna Sapaden. Administrator (AD) Olivia Hidayat was present at the facility and the purpose of the inspection was discussed.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story home with four client bedrooms, two staff rooms, three bathrooms, and attached two-car garage. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed one of four clients present. Client was observed engaging in day program via zoom. Per AD, three clients were away at day program. Bathrooms were observed to be free of debris and mildew, and faucets and toilets were operational. Water temperature tested at 118.4 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated March 12, 2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Sharps and all toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to clients. Medication cabinet was observed to be locked. LPA reviewed medication and medication administration records for four of four clients and did not observe any discrepancies.