Facility Evaluation Report

Licensing Program Analyst, LPA Noel Wolf Petersen arrived unannounced to the facility. LPA Met with Elizabeth Rodridguez Yien to explain the purpose of the visit. two bedrooms, two clients each and a staff room. there is one bathroom.

Physical Plant was inspected including the kitchen, bedrooms, bathrooms, exterior and evacuation route gate. Facility is clean, the traffic areas are unobstructed and well lit. the Kitchen, has storage space for toxics, sharps, and medication. there is food for 2 days perishable and 7 days non perishable foods. the bathroom has hardware in good repair, the water measured at the basin was between 105 and 120*F. the bedrooms, have required furniture and furnishings. the exterior is clean and space for activites, the evacuation route gate swings feely and latches closed. the extinguisher is dated 9/19/25, the CO and smoke allarms are functional, first aid kit has all necessary items.

LPA checked 2 mars and medications at random, in accordance with each other. the LPA reviewed documentation for refusals/PRNs/destruction. LPA checked 2 clients at random balance sheets, and monies, they are in agreement.

Staff files were reviewed including the health screanings, backround cheacks, recent and continuing trainings, and first aid/cpr. Files are present and up to date. Client files were reviewed including the admission agreements, health screenings, ipps, and most recent 602's. files are present and up to date

Administrator files were reviewed including the insurances, administrator certificate, facility license, required posters(ombudsman, personal rights, evacuation route, and menus) infection control plan, and evacuation plan. files are present and up to date. LPA asked for 2h of HIV/Bloodborne Pathogens training for the administrator to be emailed to the LPA, noel.wolfpetersen@dss.ca.gov. No Citations as part of this visit. a copy of the report was read and left with the administrator, exit interview conducted.