Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA met with Licensee, Etta Simpson, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (1) clients present.

The facility is a two story home with (3) client bedrooms and (2) client bathrooms with laundry room and attached garage. The upstairs is comprised of (1) staff bedroom and (1) staff bathroom.

The facility is approved for (4) ambulatory clients. LPA observed (1) client in care who had a LIC602 noting the client is non ambulatory, however the LIC602 does not have the date, name or signature of the attending physician or the result of the last TB test. LPA conducted client and staff interview, which revealed they are able to evacuate and conduct transfers on their own. Based on incomplete and conflicting information, LPA issued a citation for the client to have a new completed LIC602 on file. The licensee agreed to provide an update LIC602 as a correction and ensure all clients admitted are compatible with the facility fire clearance.

The facility is licensed as an Adult Residential Facility serving adults ages 18-59. LPA reviewed records for client in care which revealed they are over the age of 59. LPA issued a technical advisory note and advised the licensee on Acceptance and Retention Limitations for ARF facilities.