Facility Evaluation Report

At approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Joannalyn Agbayani, Designated Responsible Party. Licensee, Evelyn Samson was contacted via telephone, arrived at approximately 10:45 AM and was present for approximately 1 hour during facility tour. During such time, Licensee expressed the desire to appoint DRP as the facility Administrator permanently. LPA informed Licensee that a list of the required documentation by Licensing will be included in today's inspection report. Facility is an Adult Residential Facility with four (4) ambulatory clients in care, all of whom were away at Day Program during today's inspection. Facility is vendorized with North Bay Regional Center (NBRC).

At approximately 10:35 AM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature 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. LPA advised DRP to ensure no towels are hanging in communal bathrooms and that trash cans in the bathrooms have lids on them to bring the facility into compliance with regulations. Clients' bedrooms were inspected and observed to have all of the appropriate furnishings as outlined in Title 22 regulations. 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. Medications were centrally stored and locked. There is a shaded area in the backyard with outdoor space for activities. LPA observed a locked storage shed in the backyard which contained mostly chemicals and tools. Additionally, LPA observed a deadbolt style lock on one of the two backyard gates and advised Licensee and DRP to replace it with a regulatory compliant latch lock. Both agreed to have it replaced immediately. LPA was informed that all clients have their own internet access devices and the facility has internet available to clients in care. The facility telephone was tested an operational during today's inspection.