Facility Evaluation Report

On 05/01/2023 at 9:45am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPA was greeted by Staff Member(SM), Maribel Castillo and explained the purpose of the visit. LPA asked SM Castillo to call the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. Shortly after, LPA met with FDA Eulerina Koester.

This facility is licensed to serve and retain up to 6 residents at this time. This facility is also vendorized by Valley Mountain Regional Center to hold and accept Level 3 residents at this time.

Current Census was 4. 3 out of 4 residents were out at their respective day programs at the time of the visit.

At 10:00am, LPA reviewed 4 resident files. 4 out of 4 resident files were current and up to date. LPA reviewed 4 staff files. 4 out of 4 staff files were current and up to date. The FDA has a current and active administrator certificate #6015534735 and expires on 05/20/2024.

At 11:00am, LPA iniatied a tour with FDA Koester.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Cal State Fire and was valid until 12/07/2023.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable and non-perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.