Facility Evaluation Report

Licensing Program Analyst (LPA) A. Canela arrived at this facility unannounced, to conduct an Annual Required 1 year inspection and met with house manager, Estella Constantino; Christina Noblejas arrived a few minutes later. There are currently 5 clients living in the facility and they receive services from North Bay Regional Center. Facility is licensed for up to 6 Clients, of which 4 can be non-ambulatory and 2 will need to be ambulatory. No approval for bedridden residents. Facility has awake staff as there are no bedrooms for staff to sleep in.

Facility was found to be at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be charged and inspected 5/11/2023. Toxins are stored and not accessible. Facility has PPE supplies. Client medications are secured and locked. Facility has a 30-day supply of medication. LPA consulted with facility and provided information for requesting all non-ambulatory clients. LPA also consulted with facility regarding the push door that is getting a little stuck and will need to be serviced. LPA also reminded facility room #1's bathroom can only be used by the clients in room #1.

Due to technical difficulties with the Care Tool, LPA will return to facility to complete inspection,

Licensee/Administrator to submit updates of the below documents to LPA by 1/3/2024 and LPA will review and update file.

· LIC 308 Designation of Facility Responsibility

· LIC 400 Affidavit Regarding Client/Resident Cash Resources

· LIC 9020 Register of Facility Residents

Infection Control Plan of Operation (If changes)

No citations issued during todays inspection.