Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds, including attached garage and backyard. No accessible bodies of water or fire safety hazards are observed. There are 4 private bedrooms, two full bathrooms, living and dining room, kitchen and office area. PPE and food supplies are adequate. 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 115 degrees. First-aid kit is inspected and complete. Perishable and non-perishable food supplies and PPE supplies are adequate. A Disaster and Mass Casualty Plan is posted. There are 4 residents present, and 3 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as other staff records. Amy Hellyer is a certified ARF administrator (x 8/27) that oversees facility operations. Client records are reviewed. Facility has an approved medical waiver to practice Christian Science, and does not handle medications, nor is required to maintain medical assessments for clients and staff.

The following forms/information are requested to be submitted to CCLD BY 11/12/25:

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

Proof of current surety bonding is given to LPA today.

Deficiencies of the California Code of Regulations, Title 22, Division 6, are cited on following pages.