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 Alicia Valtierra Vazquez, Lead Direct Support Professional (DSP) .

LPA toured the facility and observed all exits were unobstructed. The facility was found to be clean, sanitary, in good repair, and at a comfortable temperature. Staff and client records were reviewed; Staff have current CPR/first aid certifications in file. 2 fire extinguishers was charged and serviced 03/09/2023. 4 smoke detectors and 1 combination carbon monoxide/smoke detector were tested and observed operational. LPA observed client bedrooms are fully furnished per regulation. Liquid hand soap and paper towels were available in 2 of 2 bathrooms. Facility food supply was within regulation. P & I funds were secured and not commingled. Medication was observed locked and inaccessible to clients in care. Detergent and cleaning supplies were observed locked in the garage.

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