Facility Evaluation Report

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Tina White. LPA began inspection with introduction, business card and visit purpose. Upon arrival LPA learned that four (4) clients reside at this facility and there are currently one (1) staff present; clients were leaving to Program and transportation was waiting. There is an Infection Control Plan on file. Administrator Chris Davis arrived during the inspection.

Client Records-Incident Reports/Clients Rights-Information/Dental- LPA began review of client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA interviewed one (1) staff. LPA completed the following domains: Infection Control and Client Rec-Incident Reports. At this time the annual continuation will conclude the annual by another LPA.

Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. LPA advised Chris that his assigned LPA is Valerie Flores.

This report was reviewed with Chris Davis and a copy was provided at the time of the exit interview.