Facility Evaluation Report

On 5/16/2024, Licensing Program Analyst (LPA) Jaime Vado to conduct an unannounced Required -1 Year visit. LPA met with administrator/licensee - Ligaya Bruce-Badilla and explained the purpose of this visit.

LPA was allowed entry into the facility that is licensed to serve 6 residents ages 18-59. Annual Fees are current. This is a four level facility. Clients reside on three of the four floors. The physical plant was toured inside and outside to ensure the safety of the clients. LPA observed the Infection Control Plan during this visit. The last documented emergency drill was conducted and recorded to be conducted in 03/08/24. LPA observed the medications area to be locked. Facility is equipped full fire alarm system, fire extinguishers, smoke and carbon monoxide detectors, central heating and air in the facility. The facility is equipped with sprinklers on all floors. Fire extinguishers are observed on every floor with inspection date of 05/17/2023. Water temperature tested in client restroom at 112F. Fire panel last inspected on 05/17/23. Medications supplied by Ted's Village Pharmacy and Anchor Pharmacy.

LPA observed 3 staff and 3 client files during this visit. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. P&I monies are inspected and accounted for for all clients reviewed. Administrator certificate expires 06/08/24 for Ligaya Bruce-Badilla.

The following updated forms are requested to be submitted to CCLD by 05/23/2024 :

• Updated surety bond with expiration date

• LIC 308 Designation of Administrative Responsibility

• LIC400 Affidavit Regarding Client/Resident Cash Resources

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Report is reviewed with the administrator and a copy of the report is provided.