Facility Evaluation Report

08/05/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 4 clients in care. Upon arrival, no clients or staff were present. LPA contacted Administrator, Zina Lee. Administrator arrived at approximately 11:00AM.

LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA spoke with administrator about ensuring facility has 2 day supply of perishable and 7 day supply of non-perishable food.

All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to clients in care were measured at 115.1 degrees which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected September 2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Chemicals were located in the laundry room and found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be recorded on the Centrally Stored Medication Record, however expiration dates were recorded incorrect (Technical Advisory). Facilities last emergency/fire drill was conducted 05/05/2025. Administrator notified LPA, clients do not have cash present at the facility, they have a trusted account.

LPA conducted a review of 2 client records. All records had the required documentation. LPA conducted review of 2 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file.