Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds. There are 6 private client bedroom--2 with private half bathrooms--and 2 full bathrooms, as well as living room, family room, dining room, kitchen and staff room. All client rooms have direct exits to outside. The backyard is level, fenced and paved. Washer and dryer are located in one of two garages; the other garage is used by two live-in staff. No accessible bodies of water or fire safety hazards are observed. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Soap and paper towels are present in bathrooms and kitchen sink. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature tested at 118 degrees. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as valid first-aid training. Dominica Oliva (x 2/26) is a certified RCFE administrator that oversees facility operations. Client records are reviewed, and Centrally Stored Medications Records are maintained for clients' medications.

Licensee is requested to submit the following information/forms by 6/4/25:

- Designation of Facility Responsibility (LIC308)

- Facility Floor Plan (with dimensions, including staff room designations and bathrooms)

Deficiencies of the RCFE Regulations, California Code of Regulations, Title 22, Division 6, are cited on following pages. See also Technical Violations issued--2 pages.