Facility Evaluation Report

At approximately 09:40 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by lead staff Raquel Cistac. Raquel advised that their newest client of 5 day, (C1) was having a behavioral expression, with a documented history Self Injurious Behaviors (SIB). LPA observed 2 and 3 staff members at times helping (C1) to avoid injuring themselves. LPA noted that C1 had scratches on their face, as well as a prominent black/purple black eye. LPA inquired as to if, Community Care Licensing (CCL) was notified within 24 hours by phone or writing of the events leading up to and the injuries, to which the licensee indicated 24 hour notice was not made. LPA spoke by phone with the licensee who promised to submit a Special Incident Report (SIR) within 7 days as required by regulation. (Technical Violation issued)

Facility is an Adult Residential Facility (ARF) with four (4) ambulatory clients in care. One client was away with family, while another was away at day programming and two were present during today's inspection. Facility is vendorized with North Bay Regional Center (NBRC).

At approximately 11:20 AM, LPA initiated a tour of the facility with lead staff and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to clients. Clients' bedrooms were inspected and observed to have all of the appropriate furnishings as outlined in Title 22 regulations. Facility was noted to feature 2 large bathrooms with walk-in showers. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. In addition, LPA observed emergency go-bags, as well as, emergency kits with food that will last 5 years.