Facility Evaluation Report

Licensing Program Analyst (LPA), Tiffany Holmes conducted an unannounced case management visit. LPA Holmes introduced herself and was allowed entry into the facility and explained the purpose of the visit to Cesiah Serrano, House Manager.

Today’s visit was regarding client health checks. During today’s visit LPA toured the facility inside and out and observed other pertinent items in the facility.

*LPA observed the Medication Administration Record (MAR) and medications for one client. House manager admits that they did not give Client 1 (C1) their nasal spray for 3 days. Dates of incidents: 03/28/2022, 03/30/2022 & 03/31/2022. LPA also observed two couches in the back yard with the springs exposed.

*LPA observed dog feces in the backyard along with cushion stuffing (from the couch pillows) all around the back yard. LPA also observed six holes in the wall/door that need to be fixed and two outlets in the master bedroom that need to be fixed.

*LPA observed a rusted rake that was broken outside in the backyard behind the shed.

Based on todays visit, these deficiencies are cited in accordance to the California Code of Regulations, Title 22, Division 6, Chapter 1, and is noted on the attached LIC809-D.

An exit interview was conducted with Cesiah Serrano, House Manager A copy of this report, and the Licensee/Appeal Rights (9058 01/16) were provided via e-mail. An electronic read receipt verifies receipt of these documents.