Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced required annual visit

to the facility. LPA met with Co-Administrator Morris Pippins at 10:15 a.m. and explained the reason for the visit. When the LPA arrived, there were two (2) staff and one (1) client present.

At 10:28 a,m. the LPA and Administrator conducted a tour of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of three (3) clients bedrooms, one (1) office/staff room, and two (2) bathrooms. The home is vendored by Tri-Counties Regional Center as a level 4-H home. The LPA observed a fire extinguisher at the facility, which was fully charged and last serviced 04/25/2024. All smoke alarms and carbon monoxide detectors were tested and operable. LPA observed all required postings throughout the facility.

KITCHEN: The kitchen was clean and appliances appear to be operable. Knives are stored in a locked box in the kitchen. The supply of perishable and nonperishable food is adequate. There is an emergency supply of food and water in the garage. There is a freezer in the garage with more perishable food. No flies or other vermin were observed.

BEDROOMS: All client bedrooms were clean, appropriately furnished and had sufficient lighting. This facility has 24/7 awake staff.

RESTROOMS: There are two (2) total bathrooms at the facility. Both can be used by clients. The resident bathrooms have a shower with non-skid materials. The toilet and showers have grab bars. The hot water temperature was tested in the hall bathroom which is the bathroom primarily used by clients; the hot water temperature measured 114.4*F which is within the regulatory range of 105*-120*F.

Report will continue on LIC809-C, 2nd page.