Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted a unannounced Required - 1 year Evaluation on 11/18/2021 attempted 10:00 am. LPA returned at 12:30 PM to complete the visit. LPA met with Administrator/Administrator (AD) Michele Atkins. Administrator's Certificate #6031560735 expires 7/27/2022.

LPA toured the interior and exterior of the facility with AD. The facility is a single story home. LPA observed food services. There was enough food on hand to meet the 2 day perishable and 7 day non-perishable requirement. Clients are Tube fed Gastrostomy-Jejunostomy. Medications were centrally stored and inaccessible to clients . LPA was able to confirm medications were being administered per physician's orders. Smoke detectors and carbon monoxide detectors ware observed operational. LPA measured hot water temperature which measured 113.1 degrees F. Fire extinguisher was observed mounted and charged, expires 04/26/2022. LPA discussed emergency preparedness with AD Atkins.

, wed 2 client files. Items reviewed but not limited to were IPP, Physician's report, TB test results, Personal Monies, and medications with no concerns noted. LPA reviewed staff files. Items reviewed but not limited to health screening, TB and CPR/First Aid training with no concerns noted.

The following documents needed to be submitted to licensing by January 11, 2022:

Admissions Policies and Procedures, Plan of Operation, Fire Clearance - Copy, Administrator Certificate, and Transportation Policies, and a copy of Surety Bond

LIC 308 Designation of Administrative Responsibility

LIC 400 Affidavit Regarding Client Cash Resources

Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed or cited today. Failure to correct cited deficiencies by the noted due date; civil penalties may be assessed.

Exit interview conducted. A copy of this report was left with Administrator.