Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Required - 1 Year inspection and met with Marissa Gueco, House Manager.

LPA toured the facility and observed all exits were unobstructed. The facility was found to be at a comfortable temperature.

Fire extinguisher was charged and serviced 05/02/2023. Carbon monoxide detector was tested and observed operational. LPA observed a supply of PPE, linens (bedding, towels, etc.), and disinfectants/cleaning solutions (observed locked). Client bedrooms were furnished per regulation. Facility food supply was within regulation. Medication was centrally stored and locked. LPA reviewed staff and client records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file. Client's records are up-to-date. P&I cash resources for clients were locked and not commingled. Water temperature was tested and was within regulation of 105-120 degrees F.

LPA requested the following updated forms to be submitted to Community Care Licensing by 06/26/2023:

· 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 during this inspection