Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai spoke with Administrator (ADM) Fredricka Safar over the phone and stated the purpose of today's visit. LPA Rai received verbal authorization for Lead Staff, Jean Berries to sign the report on ADM behalf for today's visit. LPA Rai observed 2 staff and 2 residents at the facility, as 4 residents were out of the facility attending 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 1 shed in the backyard which was locked and used for storage and not habitual space. LPA Rai observed a pool with a locked fence around the perimeter. 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 sinks ranged from 110 - 112 degrees F.

Fire extinguisher was observed and inspected on 8/2/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 09/20/2025 and 11/19/2025. 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 Lead Staff, Jean Berries and a copy of the report was provided. LIC 858 and LIC 859 were provided.