Facility Evaluation Report

Licensing Program Analysts (LPAs), Alviso and Contreras, conducted a Required - 1 Year inspection, on 2/24/25 at approximately 9:20am, and met with Administrator Eddah Khara. All residents were at day program and/or their jobs during the inspection.

Facility has received a fire clearance approval for four (4) ambulatory clients. Fire extinguishers were observed to be charged as required. Facility has smoke alarms and a carbon monoxide detector as required. Facility has a required infection control plan. Facility has required emergency disaster plan.

LPAs reviewed four resident files, medication records/storage of medications, and P&I resident cash resources/records of P&I cash. P&I monies were maintained as required, and was observed to not mixed with facility funds and/or any other funds.

LPAs reviewed four (4) staff files. All staff had required criminal record clearance. Three staff had required first aid certification.

LPA toured the facility with the Administrator. Bathrooms were clean, had shower mats for residents use. Had required furnishings. There is a medication cart that was observed to be locked. Cleaners/disinfectants were locked in a storage cabinet in the garage. The facility was observed to be at a comfortable temperature. The backyard was toured and the fire exit gate opened properly during the inspection. Hot water was checked at 109.4 degrees Fahrenheit, which is within regulation.

The following forms are to be submitted by 3/24/25:

LIC308 - Designation of Administrator Responsibility

LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required)

Infection Control Plan (ensure to review and update as needed/required)