Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds, including detached garage and two storage sheds. All passageways are unobstructed and there are no accessible bodies of water or safety hazards observed. Medications and sharps are stored appropriately and inaccessible to clients. Hot water temperature is tested at 112 degrees in main shower/bathroom. Food supply--consisting of liquid formula for 3 clients and regular food for one--and first-aid kit are inspected, and hygiene items for general use are maintained, as well as PPE. All residents have Hill-Rom hospital beds with full bed rails, which were approved for use by a facility wide waiver. Disaster drills are documented and are conducted regularly; the most recent one was done in December 2025.

Client files are reviewed, including review of client's medications, which are recorded on Centrally Stored Medications Records. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including required staff records. Madonna Valencia and Claire Ascalon are certified ARF administrators (x 10/27 and 6/26) that oversee facility operations for this Adult Residential Facility for Persons with Special Health Care Needs. Facility employs LVNs and RNs around the clock to administer nutrition, hydration and medications; professional licenses for LVNs and RNs on premises are verified as current.

There is no staff room, as facility employs awake night staff.

The following updated forms are given to LPA today:

Deficiency of the California Code of Regulations, Title 22 is cited on a following page.