Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds. There are 3 private client rooms, 2 bathrooms, living room, kitchen/dining room, staff room with 4 beds. Washer and dryer are located in attached 2-car garage. Backyard is level, partially paved, and fenced.

There are no accessible bodies of water nor fire safety hazards observed. Medications are stored appropriately and inaccessible to clients, and a comfortable temperature is maintained. Hot water temperature is tested bath/shower room. Food supply and first-aid kit are inspected, and hygiene items for general use are maintained. All client files are reviewed, including clients' personal and incidental transaction records and Centrally Stored Medications Records. Disaster drills are conducted and documented. The last one was performed 5/10/25. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Eleanor Basa is a certified ARF administrator (x 8/26) that oversees facility operations.

The following updated information/forms are requested to be sent to CCLD BY 7/11/25:

- Proof of control of property (signed, dated, current lease agreement)

- Emergency Disaster Plan (LIC610D--9 page version, with page 9 signed and dated)

Deficiencies of the California Code of Regulations, Title 22, are cited on following pages.