Facility Evaluation Report

Licensing Program Analyst, Noel Wolf Petersen arrived unannounced to the facility 10:45am to conduct annual inspection. LPA met with Administrator Heather McClosky and explained the purpose of the visit. Davis Guest Home 3 is a RCFE accepting clients with a cooccuring mental Illness ages 60+. Currently no residents have a restricted condition.

Physical inspection, included but was not limited to: the kitchen, common areas, bedrooms, bathrooms, exteriors, storage areas, and emergency exit routes. The kitchen had adequate lockable storage for sharps, medication, and toxics. The food was in adequate supply for 2 days perishable, 7 days non perishable for 10 people at 3 meals 3 snacks a day. The bathrooms had hardware in good repair, water temperature was measured 105-120*F. The bedrooms have required furniture, including mattress encasements. Exteriors have some high grass that might constitute a tripping hazard soon. emergency exit route gate is a front gate in good repair, it's unlocked, swings freely, and can latch closed.

Resident records, included but not limited to: the needs and services plan, recent medical assessments, and signed admission agreement and any amended consents. Resident records are complete and up to date, 1 client file had a signature by an LMFT on a 602, a more recent 602 had an appropriate medical professional on the signature line. LPA gave guidance that the 602 can be signed by a MD/DO, NP, or PA, and the 603 can be signed by a MD/DO. 1 client is planned to have an updated 602 shortly to have a temporary foley catheter removed before he returns to the facility.

P+I funds are comingled, out of compliance with 87217(e), the LPA asked for the funds that are in the facility be stored seperately for each client such that there is not a single pool from which all funds are drawn. Facility should send a photo of the new storage solution by 3/17/2026.