Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Susana Quisquino, house manager. Administrator was not available during time of inspection.

LPA toured the facility and observed all exits were unobstructed. Fire extinguisher was charged and serviced 10/14/2022. Carbon monoxide detector was tested and observed operational. LPA observed liquid hand soap and paper towels available in bathrooms. LPA reviewed staff and client records. Staff have completed cardiopulmonary resuscitation (CPR) training and first aid training. Food supply was within regulation. Client medication was centrally stored.

LPA requested the following updated forms to be submitted to Community Care Licensing by 05/08/2023:

· LIC 308 Designation of Facility Responsibility (1 person per form)

· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents)

· Copy of current Administrator's Certificate

Exit interview conducted with house manager whose signature on this document confirms receipt. No deficiencies cited.

Report copy sent to Administrator by email.