Facility Evaluation Report

On November 03, 2023, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct an annual licensing inspection, and met with the Administrator Blaine. The LPA introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is licensed to serve two adult residents, but currently only has one resident.

Physical Plant: The facility is a two story home located at 42120 Vai Del Gavilan Fallbrook, Ca. 92028, and the land- line phone number is (760) 746-9164, and is operable. The LPA observed the resident's bedroom, and it was equipped with required furniture as per Title 22. The LPA inspected the facility bathroom, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher, and a first aid kit with manual. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the resident. There was a designated space for the resident and staff files. Medications : The medications were, locked, and inaccessible to the resident. The overall facility is clean, and the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there were a variety of food types. Dishes and utensils are in sufficient supply and stored properly. Care & Supervision : Facility has sufficient staff, one caregiver at the time of this visit, and the staff was attentive and engaging the resident. Records Review: The LPA reviewed one resident file, two staff files, and reviewed previous CCL forms. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit. An exit interview was conducted and a copy of this report was given to the Administrator, Blaine Kanzelman.