Facility Evaluation Report

On 1/18/2022 at 9:40 am, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong called the facility and spoke to staff, whom confirmed no residents or staff have had any symptoms of COVID-19 in the last 10 days. Upon LPAs arrival, Staff Christopher Carillo was present at facility and contacted Administrator Jaime Gacilan. LPA Truong spoke with Administrator Jaime Gacilan on the phone and explained the purpose of today’s visit. LPA Truong was advised that staff Christopher can assist LPA with today’s inspection and sign the report.

Administrator holds current certification #6019377735 and expires on 9/8/2022. The facility is licensed to serve (6) six non-ambulatory developmentally disabled adults. Age range 18 through 59 years. There are currently 6 clients who reside at this facility. LPA toured the facility with Christopher Carillo on 1/18/2022 at 10:00 am.

LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The hot water temperature was observed to be 115 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 72 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable.