Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Leilani Jocson, Administrator .

LPA toured the facility and observed all exits were unobstructed. The facility was found to be clean & at a comfortable temperature; screening station was observed at front entrance.

2 of 2 fire extinguishers were charged and serviced 09/06/2022. There are 7 hardwired combination smoke and carbon monoxide detectors, which were tested & observed operational. LPA observed a supply of PPE, emergency food/supplies, linens (bedding, towels, etc.), and disinfectants/cleaning solutions (observed locked & inaccessible). Liquid hand soap and paper towels are available in 2 of 2 bathrooms. 4 of 4 client bedrooms were furnished per regulation. Facility food supply was within regulation and accessible to clients. Medication was centrally stored and locked. Client P & I Funds are locked and not commingled.

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