Facility Evaluation Report

On 04/26/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection visit. LPA met with direct support professional/caregiver and explained the purpose of today's visit.

This facility is a one story residential home licensed to provide services to adults 18 years of age and older, all of which need to be ambulatory. All clients are out of the facility at day program or outings. LPA toured the facility inside and out with Francis. Resident bedrooms were furnished, clean, and free from uncommon odors. Client bathroom is fully stocked with paper towels, a trash can, toilet paper, and hand soap. Water temperature is tested at 105F. Common areas are fully furnished. Sharps, toxins, and cleaning supplies were locked away and inaccessible to clients. Sharps such as knives are locked in a drawer adjacent to the stove. Medications are locked in a hallway closet adjacent to resident rooms. 7 day and 2 day food supply is in place. 2 refrigerators are present and one freezer in the facility. LPA observed fire extinguishers, a fire pull alarm system, and carbon monoxide detectors to be in working condition. Extinguishers are last inspected on 11/14/2023. Facility is also equipped with full fire sprinkler system. The facility does not have a record of disaster drills being conducted available for review.

LPA reviewed 2 staff files and 1 resident files. Staff files are observed to be complete with up to date training and background clearance. First aid cards for 2 of 2 staff files are observed to have expired on 02/2022. Resident file observed to be up to date with necessary documents. Facility does handle client monies. LPA reviewed 1 of 3 clients money at the facility and it is in place and accurate to the log and monies counted. Facility administrator's certificate is observed as current expiring 10/10/2024.

The following updated forms are being requested to be received by 05/03/2024:

• LIC 308 Designation of Administrative Responsibility

• Surety bond for resident cash with expiration date

Per California Code of Regulations (CCR) - Title 22 - Deficiencies were observed today on the following LIC809D. Technical violations are cited on attached LIC9102TV.

Report is reviewed with Francis and a copy of the report was provided.