Facility Evaluation Report

On 12/01/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required annual visit. LPA contacted Administrator on record (ADM), Emily Carpenter, who arrived to the facility shortly after LPA. District Manager (DM), Jose Marquez and Regional Director(RD), Mauricio Villatoro also arrived to the facility. LPA stated the purpose of the visit and was allowed entry into the facility.

LPA requested Individual Performance Plans (IPPs) for all residents in the home. ADM provided 3 out of 4 IPPs at the time of the visit. 2 out of the 3 IPP's were observed to be dated 2022. LPA requested Annual Functional Behavior Assessments (AFBA) for all residents in care. ADM provided 3 out of 4 AFBAs at the time of visit. 3 out of 4 resident's AFBA were observed to be dated 2022.

LPA requested Personnel Report (LIC500) and current staff training for all personnel listed on LIC500. ADM did not provide proof of staff training at the time of visit.

Records review of the facility show there is not a current Administrator Certificate for Emily Carpenter. Certificate expired 10/21/23. There is no record of application sent to CCL for this certificate to be recertified.

LPA toured the facility with RD's and ADM. No resident's were home at the time of the tour. Facility is observed to be a 4 bedroom, 2 bathroom house. The facility was observed to be unclean and in disrepair.

The following observations were made during the tour:

Living Room was observed to have a ripped couch and chair. RD's stated new furniture has been ordered and was scheduled for delivery today.

Dining Room was observed to have a broken window blind, floor tile under the table is scratched and discolored, drill holes in the wall that need filling/repair and reminisce of old stickers are observed on the kitchen cabinet.

Kitchen was observed to have a dust/grease stain on the wall above the exhaust vent, microwave was observed with a broken handle. Refrigerator was observed to be dirty inside and out and the sealing on the fridge door is separating from the door.