Facility Evaluation Report

At approximately 12:35PM Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Sarway Genesis. CEO, Barrett Adams, arrived at approximately 1:15PM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Ambulatory Clients. Upon arrival, LPA was informed that there were 4 clients in care with 1 client out of the facility attending Day Program. LPA was also informed that there was two staff members on-site.

At approximately 12:45PM, LPA reviewed the Facility's Staff Roster and found that Staff Member 1 (S1) was not associated to the facility as required (deficiency cited and civil penalty issued, see LIC809D and LIC421BG). Per conversation with Administrator, Momo Duoa, they have been in contact with Guardian regarding S1's association to the facility. Administrator also stated that they are responsible for ensuring that facility staff are background cleared and associated on Guardian. Administrator stated that they have proof of correspondence via email with Guardian, but was unable to provide it during visit. At approximately 1:00PM, LPA conducted a walk-though of the facility with Staff Member. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 Client bedrooms, 1 staff room, 3 bathrooms, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected December 2022 (deficiency cited, see LIC809D, regulation 80020a))

During walkthrough, LPA observed the following hazards to be accessible: knife in drawer not designated for sharps, and cleaning solution under a client's bathroom sink (deficiency cited, see LIC809D, regulation 80087(g)). LPA also discussed ensuring that perishable food is labeled and dated appropriately. LPA, CEO, and Staff Member reviewed Guardian requirements, Title 22 Regulations, and Licensing expectations.

Administrator's Certificate for Barrett Adams (7029790735) was current with an expiration date of 08/17/2025.