Facility Evaluation Report

Licensing Program Analyst(LPA), Alviso conducted a Required - 1 Year Inspection, and met with live-in caregiver, Melanie Beehner. All clients were at day program during the inspection.

Facility has an infection control plan as required. Fire clearance approval is for four (4) ambulatory. All exits were cleared and free of obstruction. Fire extinguishers, 1, was serviced and tagged as required. Emergency fire drill was held on November 14, 2023.

LPA reviewed three (3) resident files. Files were complete.

LPA reviewed five (5) staff files. All staff had required criminal record clearance. All staff had required training.

All medications were locked up and inaccessible to residents in care. All toxins were locked up and inaccessible to residents in care. All exits were unobstructed. Hot water was checked at 116.7 degrees Fahrenheit. There is sufficient lighting in the hallways, bathrooms, and common areas, as well as client rooms. Food supply was sufficient, and staff stated tomorrow, Wednesday, is shopping day. There was sufficient furnishings for clients in care.

LPA is requesting the following forms be updated and submitted by 06/30/23:

· LIC 308 - Designation of Responsibility

· Affidavit Regarding Client Cash Resources

· Infection Control Plan-if updated//any changes

Per facility file review and interviews with staff, the facility lacked the emergency and disaster plan as required. The following deficiency was cited, H&S Code1565(a), A facility shall have an emergency and disaster plan as required by H&S, see LIC809D.

The following deficiency was cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Melanie Beehner, caregiver. Appeal rights provided for the Administrator.