Facility Evaluation Report

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct an annual inspection. LPA met with Jennifer Ulloa, support staff and she was informed of the purpose of the visit.

The facility is an Adult Residential, 4i, facility. The facility has a license capacity of (6) ambulatory clients. There is currently one (1) client. During today's inspection,there was one (1) staff and the one (1) client was at day program. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant: LPA observed indoor and outdoor passageways are kept free of obstructions. The facility has sufficient indoor and outdoor space for client activities. The facility has no bodies of water. The facility is maintained at a comfortable temperature.

Client bedrooms were equipped with furniture and appeared to be in good repair. The client bathroom shower, faucets, and toilet were operating properly. Bathroom hot water temperature was tested at 117 degrees F. The facility has sufficient activity supplies for clients and client activities include community outings and day program participation. The facility has sufficient linen, personal hygiene products, and furniture for clients in care. The facility has operating telephone service, fire/carbon monoxide alarms, and laundry equipment. Cleaning supplies, and sharps were kept locked and inaccessible to clients in care.

Food Service: The facility has sufficient non-perishable and perishable food for number of client in care. The refrigerator and freezer where operating in a healthful manner. The facility has sufficient cups, plates, and utensils for client use.

Care & Supervision: Facility has care staff coverage 24 hours a day, 7 days a week.

Record Review: The facility's last earthquake drill was conducted on 1/15/2025. The Administrator's certification expires on 12/05/2025.