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 107 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, including Centrally Stored Medications Records and personal and incidental money transaction records. Disaster drills are documented and performed quarterly . Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records

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 given to LPA today:

- Designation of Administrative Responsibility (LIC308)

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