Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facilities annual inspection. LPA met with Administrator Marisol Moreno. There are currently 12 residents who receive in person services at this location. LPA inspected the interior and the exterior of the facility activity rooms, kitchen, bathrooms and outdoor areas.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 108 F degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. There are currently no residents at this facility currently taking medications

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, Emergency Disaster Plan and copy of current Administrator's current CE units to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Administrator and copy of report left at facility