Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Designated Administrator/ House Manager (HM) Filimon Zewde and stated the purpose of today's visit. LPA Rai observed 2 staff who have obtained a Criminal Record Clearance. LPA Rai observed 0 residents at the facility, since they were attending the adult day program. The facility is vendorized by San Andreas Regional Center and is a level 6 facility.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 2 shed in the backyard which was locked and used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 3 resident rooms, living room, dining room, kitchen and garage. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sink ranged from 107.6 - 110.1 degrees F. Fire extinguisher was observed and inspected on 11/12/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 10/31/2025 and 12/31/2025. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Designated Administrator/ House Manager (HM) Filimon Zewde and a copy of the report was provided. LIC 858 and LIC 859 were provided.