Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry by staff and explained the reason for the visit.

Facility is a single story, 4 bedroom, 2 bathroom house with an attached garage and a grey exterior. Facility is licensed for 6 ambulatory clients.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in bathrooms. The hot water temperature measured 115 and 118.9 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill on 10/02/2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed secured medication storage. LPA observed expired emergency food and 1 case of a 24-pack of water in facility garage. Review of the emergency plan has not been conducted since 05/2024

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of four out of four clients files. LPA observed Client 1 (C1) admission agreement is not signed by either party and based on review of records C1 had an incident that occurred on 06/08/2025 that was not reported to CCLD. LPA observed Client 3 (C3) admission's agreement was not signed by C3.

Based on observations made deficiencies are cited per Title 22. An exit interview was conducted and a copy of this report was provided along with appeal rights were provided.