Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff Custodio Laygo and was granted entry to the facility.The facility is a (4) bedroom (3) bathroom home and, with a kitchen/dining area, living room, attach garage. Licensed capacity is (6) current census (0). LPA was accompanied by staff Custodio Laygo to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 112 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated space for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Record Review: The facility does not have clients and does not have active staff members. Facility is pending to receive clients through Inland Regional Center.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to staff Custodio Laygo .