Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required one year annual inspection visit. LPA met with direct care staff and explained the purpose of today’s inspection. Total capacity of five ambulatory clients and one non-ambulatory client.

LPA and direct care staff toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 75 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared clients’ bathroom was measured at 114.2 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of seven day non-perishables and two day perishables foods. Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on July 24, 2023. Mitigation Plan observed to be complete. First aid kit was observed to be complete. Toxins and cleaning supplies are locked and inaccessible.

The following forms were received and submitted on today's date:

LIC 308 Designation of Administrative Responsibility, LIC 402 Surety Bond

LIC 610-D Emergency Disaster Plan, and copy of administrator certificate.

LPA reviewed two staff and three resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility.

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

Exit interview conducted with direct care staff. A copy of LIC 811 (Confidential Names) and report given.