Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Required - 1 Year inspection at this Adult Residential Facility and met with Silva Rosario, House Manager and Lead Direct Support Professional (DSP) . Administrator Mark Zhang arrived later.

LPA toured the facility and it was found to be at a comfortable temperature and all exits were unobstructed. Fire extinguisher was charged and serviced 04/28/2022. Liquid hand soap and paper towels were available in 2 of 2 bathrooms. Medication was observed locked and inaccessible to clients in care. Detergent and cleaning supplies were observed locked. Food supply was within regulation.

LPA reviewed some client files. LPA will return at a later date to test smoke detectors, to review staff and client records to complete inspection.

LPA requested the following updated forms to be submitted to Community Care Licensing by 05/18/2023:

· 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 DSP, whose signature on this document confirms receipt. ***No deficiencies cited during this inspection