Facility Evaluation Report

LPA Jeung toured facility and grounds. This is a single story facility with 4 private resident rooms, two full bathrooms, and a staff/office room. No accessible bodies of water or fire safety hazards observed. Alarm systems were installed on the resident doors at entry point and doors leading outside. In the kitchen, sharps and medications are locked and inaccessible to residents. PPE supply is adequate and food supplies are checked. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Soap and paper towels are present in bathrooms and kitchen sink. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Calvin Evaimalo and Godfred Garduce are certified ARF administrators that oversee facility operations.

The following licensing forms/information are requested to be sent to CCLD by 9/25/24:

- Emergency Disaster Plan (LIC610--9 page version, with signed and dated page 9)

Facility phone number is 650/931-4820 and will be corrected.

Deficiencies of the General Licensing Regulations, of the California Code of Regulations, Title 22, Division 6, are cited. See also Technical Advisory notes--3 pages.