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 09:20 a.m. and explained the reason for the visit. When the LPA arrived, there were three (3) staff and two (2) clients present.

RECORD REVIEW: At 09:45 a.m., a review of facility files was initiated. Facility records are stored in the locked hallway closet. The LPA observed documentation of Infection Control, Emergency Disaster Plan and last Disaster drill (conducted on 10/01/2025). LPA advised disaster drills need to be conducted every shift. The LPA obtained Client Roster, and Staff Roster. The LPA reviewed five(5) out of six (6) client files and five (5) staff files. All client and staff files were complete and current.

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 04/02/2025. 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. Report will continue on LIC809-C, 2ND PAGE.