Facility Evaluation Report

Licensing Program Analyst (LPAs) Simi Rai and Marcela Yanez conducted an unannounced annual inspection visit. LPAs met with Administrator (AD) Nilo Ambagan and stated the purpose of the visit. LPAs observed 2 Staff and 0 residents at the facility as 6 residents were attending the day program.

LPAs toured the facility inside and out with AD which included the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. LPAs measured the water temperature with thermometer in Kitchen sink measured at 112.4 degrees F and bathroom #1 and #2 sink measured with thermometer range from

LPAs observed a shed that was used for storage and locked and inaccessible to residents in care and not used as habitual space. LPAs observed chemicals and knives were locked and inaccessible to residents in care.

Two staff rooms and Office of the facility was also inspected. The front yard and backyard were inspected and exits were clear of obstruction and debris.

Fire extinguisher was serviced in 03/16/2024. The facility was equipped with working smoke and carbon monoxide detectors. LPAs observed flashlight and complete first aid kit. Facility fire/earthquake drill was conducted on 08/15/2024 and 09/23/2024.

LPAs reviewed facility records for 2 staff and 2 residents. LPA reviewed 2 resident medications and centrally stored medication records.

No deficiencies cited during today's visit per California Code of Regulation Title 22. This report was reviewed with Administrator (AD) Nilo Ambagan and a copy of the signed report was provided.