Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Required - 1 Year inspection. LPA was granted access into the facility by Fabricio Santos, Licensee. Administrator Maria Villalobos-Santos arrived later.

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 04/26/2023. 4 smoke detectors and 1 carbon monoxide detector were tested and observed operational. LPA observed a supply of 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. P&I cash resources for client (C3) was locked and not commingled in an individual bank account. LPA discussed Health & Safety Code 1565(c) and Title 22, Division 6 Regulations 80068.2(b)(1) and 80069(c)(4).

LPA requested the following updated forms to be submitted to Community Care Licensing by 06/30/2023:

· 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

· LIC9020 Register of facility client/residents

Exit interview conducted with Administrator, whose signature on this document confirms receipt. ***No deficiencies cited during this inspection