Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds. No accessible bodies of water or fire safety hazards are observed. There are 4 private bedrooms for residents and 2 common bathrooms. There is a 2 car garage used for storage and wood deck in the backyard. Washer and dryer are located in hallway.

A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Soap and paper towels are present in bathrooms and kitchen sink, including reminder signs to wash hands. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. First-aid kit is inspected and complete. An updated Disaster and Mass Casualty Plan is posted. Three residents receive g-tube feeding; 7-day supply of formulas are maintained. Food supply for one resident is observed. There are 2 residents present, and 2 staff. Client records are reviewed and criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records. Kaila Branch is the administrator (x 4/25) that oversees facility operations.

The following form is provided to LPA today:

The following forms/information are requested to be submitted to CCLD by 10/17/24:

• LIC 400 Affidavit Regarding Client Cash Resources

Deficiency of the General Licensing Regulations, of the California Code of Regulations, Title 22, Division 6, Chapter 1, Articles 1-7 is observed and cited on a following page.