Facility Evaluation Report

Licensing Program Analyst (LPA) Jenny Olson arrived unannounced to conduct a one year required annual inspection. LPA was accompanied by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Vince Figueroa. LPA and QAS met with Backup Administrator and explained the reason for the visit.

LPA and QAS toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Records: LPA reviewed client and staff records at 5:00 p.m. LPA reviewed three (3) client files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. All files were complete

LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. All files were complete.

The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 2 home. The last disaster drill was conducted on 6/18/2023.

Due to time constraints LPA was unable to finish the annual and will return at another date to continue the annual inspection.

Exit interview completed, copy of report was printed.