Facility Evaluation Report

At approximately 09:40 AM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required 1 Year visit and met with caregiver Arlene Miller who called licensee/administrator Virginia Punzalan who arrived at approximately 10:05 AM

At approximately 9:45 AM, LPA reviewed the facility's staff roster and found that all staff on-site were background cleared and associated to the facility per regulation on Guardian.

Facility is an Adult Residential Home that provides care and assistance for adults with disabilities. Facility has an approved fire clearance and capacity for 4 ambulatory clients. Upon arrival, LPA was informed that there were 3 clients in care with all 3 clients were out of the facility attending day programs.

At approximately 10:10 AM, LPA conducted a walk-though of the facility with licensee. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has emergency lighting. Facility is a one story building with 4 client bedrooms, 1 client and 1 staff bathroom, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use.

An exterior locked shed was observed through windows to contain various automotive tools and extra supplies.