Facility Evaluation Report

On 12/10/2024, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct their required annual inspection visit. LPA initially met with a staff on duty (S1) and stated the purpose of this visit. Administrator Fozai Hassen was out of the facility on errands but arrived shortly after. Present upon LPA's arrival to this facility were 2 residents in care with 1 staff on duty.

Facility is a one-story home located in a residential neighborhood. This facility was licensed as an Adult Residential Facility to serve 4 Adults. This facility operates as a level 4I home vendorized by Alta California Regional Center.

The interior and the exterior of the facility were inspected including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. Medications, sharp objects and dangerous chemicals were observed to be locked and inaccessible to residents in care. Food supply is adequate for 2-day perishable and 7-day nonperishable. Freezers and refrigerators were maintained at regulatory temperatures. Garage was inspected and outside physical plant was found free of debris and obstructions. Smoke and carbon monoxide detectors were observed and tested and were found in good working order. LPA observed a sufficient amount of towels and linens.

LPA reviewed three resident files, including, but not limited to, Admission Agreements, Medical Assessments, and Individual Program Plan (IPP) reports. During the review, it was noted that two out of the three residents had inconsistent ambulatory status assessments. While their medical assessments indicated they were non-ambulatory, their IPPs and Admission/Placement Agreements listed them as ambulatory. Following the discussion, the administrator will arrange for the residents to be reassessed by their primary physician regarding their ambulatory status.

Due to insufficient time, this annual visit will require a continuation visit.

Exit interview was conducted with the Administrator and a copy of this report was provided.