Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Heta Finau, Administrator, and explained purpose of inspection. LPA then met with Sione Finau, staff, who arrived at approximately 2:45 pm. LPA observed (3) clients return from day program during today's inspection. The facility is a level- 2 home, vendorized by Alta Cailfornia Regional Center.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) client bedrooms, (2) client bathrooms, kitchen, Administrators' room and bathroom, and laundry area. LPA observed the home to be clean, safe and in good repair. Inside temperature was observed to be 77*. Facility conducts monthly fire drills. The smoke/monoxide alarms work. Hot water temperature measured 108*F in the kitchen. LPA observed sufficient 2+ day perishable and 7+day non-perishable supply of food in the kitchen. LPA observed locked sharps, toxins and medications in the kitchen. First Aid kit complete with required supplies.

LPA reviewed (1) of (3) staff files and (2) of (3) client files. Files were organized and contained current documentation of training and care plans (Regional Center) done annually for a Level 2 home. (2) staff to complete required (12) hours of annual training by 12/15/23. Administrator submitted renewal paperwork and fees for Administrator Certificate on/around June 2023. LPA reviewed P&I funds for (2) clients and funds on hand match records. Medications were reviewed for (1) client - no discrepancies were found.

LPA printed out LIC610E(9 pages) for facility to complete/update. LPA reviewed the Infection Control Plan (LIC9282) completed and approved it.

Administrator to provide updated copy of LIC308, LIC500, LIC610E to LPA by 10/4/23

A technical advisory note was issued regarding Pub 475 not posted.