Facility Evaluation Report
Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a required - 1 Year visit. LPA met with Administrator Florencio Ballesteros and explained the purpose of today’s visit.
Administrator certificate expired on 7/15/2024. Renewal application is pending. The facility is licensed for four (4) ambulatory client only. LPA observed 2 clients and 3 staff present during this visit. Administrator assisted LPA in today’s inspection.
LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to clients. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 108*F which is within the required range of 105-120*F. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. All emergency exits were clear from obstructions.
LPA requested client and staff files for review. LPA reviewed four (4) client files and three (3) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.
The following forms and documents were requested to be submitted within 15 days:
LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, Administrator Certificate, Surety Bond, and LIC 610 Emergency Disaster Plan.
Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report was provided upon exit.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction