Facility Evaluation Report

LPA Jeung toured facility and grounds, including attached garage--where washer and dryer are located-- of this Adult Residential Facility for Persons with Special Healthcare Needs. There are 4 private client rooms, each with exits to outside. Facility maintains facility-wide waivers for full bed rails for all clients' beds and alternative assistance with administering PRN medications. Electronic hoyer lifts are installed in all bedrooms and bathroom for lifting residents. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients. A comfortable temperature is maintained. Bathing facilities for clients are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 113 degrees in clients' bathroom. Only one resident eats by mouth. Food--consisting of formula and regular food--PPE supplies and first-aid kit are maintained. Client records are reviewed, including Centrally Stored Medications Records and clients' cash resources logs.

A Disaster and Mass Casualty Plan is posted. There is no staff room, as facility employs awake night staff.

Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Roger Fujii is a certified ARF administrator (x 1/27) that oversees facility operations.

The following information/forms are requested to be completed and sent to CCLD by 7/31/25:

- Affidavit Regarding Client Cash Resources (LIC400)

Deficiency of the California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. See also Technical Advisory Note--one page.