Facility Evaluation Report

On 11/07/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Administrator, Monica Arroyo and explained the purpose of the visit. There was one other staff member present at this time, Kristina Tofting.

Current Census was 6. 5 out 6 residents were out at their respective day program.

This facility is licensed to hold 6 ambulatory residents and is vendorized by Valley Mountain Regional Center to hold Level 4I residents at this time.

Administrator holds a current Administrator certificate #6044527735 and was valid until 11/06/2023, however the Facility Designated Administrator has provided the department documentation for renewal and is awaiting for a new certificate. LPA reviewed 3 resident files and 3 staff files. All 3 staff files were current and up to date.

LPA Pascua initiated a tour with Administrator Arroyo. Smoke detectors and carbon monoxide were in good repair.

The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair.

A tour of the kitchen was conducted. LPA Pascua observed a sufficient amount of 2-day

perishable food supply in the refrigerator and a 7-day non-perishable food supply in the pantry for 5 residents. Knives were observed to be locked and made inaccessible to the residents at this time. Cleaning supplies were also observed to be locked under the kitchen sink and made inaccessible to the residents in care. A fire extinguisher was also observed to be in the kitchen and was annually inspected by Nor Cal Fire on 10/31/2023.

LPA Pascua observed a locked centralized stored medication cabinet located in a locked closet under the stairs. Along with the Administrator Arroyo, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the garage was conducted. Additional food supply was identified in the refrigerator located in the garage. Additional toiletries and supplies were also identified.