Facility Evaluation Report

On 7/30/2026 at 9:17 AM Licensing Program Analyst Attempted to conduct the required annual inspection visit. LPA knocked and rang door bell, no response. LPA left a voicemail message for Licensee. Licensee returned LPA call and LPA conducted a second visit today at 1:55 PM. LPA met with Licensee, Sriadi Sutiningsih, and discussed the purpose of the visit. The facility is an Adult Residential Facility with a license capacity of (4) and a current census of (4). The facility is a vendorized by Inland Regional Center (IRC). During today's inspection, all four (4) clients were in attendance at the Day Program. LPA conducted an overall inspection, which included, but was not limited to, the following:

Operation/Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 79 degrees F. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms and kitchen to be 105.9, 108.5 and 101 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 storage space for client/staff files. LPA observed medication closet to be locked and secured with medication, and first aid kit and book. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Food Service: The facility’s dining and kitchen areas were maintained and clean. The facility has sufficient amount of non-perishable and perishable food for number of clients in care. LPA observed one expired can good dated May 2026 and a loaf of bread that expired on July 29, 2026. Licensee removed items immediately and agreed to conduct another inventory of all food. A Technical violation issued.

Health Related Services: Clients medication are centrally stored in a locked cabinet. During today's audit of the clients MARs LPA observed that 1 out of 2 clients MARs was missing a initial for two (2) medications that were dispensed and one medication was still in the bubble and had a initial on the MARs stating it was issued. A Deficiency cited .