Facility Evaluation Report

Licensing Program Analyst (LPA) Audrey Jeung toured facility and grounds of this 2 story home, consisting of three client bedrooms on the 2nd floor--2 private and one shared--and five staff rooms on the 2nd floor--4 with a bed in each. There are two full bathrooms for staff and a full bathroom for clients on the 2nd floor, and a full bathroom on the ground floor, which consists of common areas--living room, sitting room, dining/family room, and kitchen. There is a large deck that is accessed from ground floor family room. There is a 2-car garage, where washer and dryer are located. A comfortable temperature is maintained and lighting is sufficient for comfort and safety. Water temperature is tested in main bathroom on 2nd floor. Medications, sharps, and chemicals are observed locked and inaccessible to residents. Food supplies of perishables for 2 days and non-perishables for 7 days are maintained. First aid kit is observed to be complete. Carbon monoxide detector is tested and operable. There are 4 regional center residents present, and 2 staff.

Client records are reviewed. Centrally Stored Medication Records and staff records will be reviewed at a later date, due to time constraints. Yu Heung Kwok is a certified RCFE administrator (x 10/26) that oversees facility operations.

The following information/forms are requested to be submitted to CCLD BY 8/14/26:

- Designation of Administrative Responsibility (LIC308)

- Emergency Disaster Plan (LIC610E, including signed and dated page 9)

- updated Facility Sketch, showing room designations

Deficiencies of the California Code of Regulations, Title 22, are observed. See Technical Advisory Notes --4 pages. Report is reviewed with administrator and a copy is provided.