Facility Evaluation Report

LPA Audrey Jeung, toured facility and grounds of this Adult Residential Facility for Persons with Special Healthcare Needs. There are 4 private client bedrooms, all equipped with overhead electronic hoyer lift systems. There are no accessible bodies of water nor fire safety hazards observed, and passageways are unobstructed. All residents use oxygen, and appropriate signs are posted. All residents have gastrostomy tubes, and one client eats by mouth. Carbon monoxide detector is tested and operable. A comfortable temperature is maintained and lighting appears adequate for safety. Hot water temperature is tested at 108 degrees in client bathroom. Food supply--including liquid formula for 2 clients--and first-aid kit are inspected, and PPE and hygiene items for general use are maintained. Client files are reviewed, and medications are recorded on Centrally Stored Medications Records. Disaster drills are documented and performed every other month. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Claire Ascalon maintains ARF certification (x 6/26). There is no staff room, as facility employs awake night staff.

The following updated licensing forms are requested to be sent to CCLD BY 12/17/24:

- Designation of Administrative Responsibility (LIC308)

Updated Emergency Disaster Plan (LIC610D) is given to LPA today.

No deficiencies of the California Code of Regulations, Title 22, are cited. Facility is operating in substantial compliance.