Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. At 10:30 a.m., the LPA arrived at the facility, however no one answered the door nor the telephone. LPA returned to the facility at 02:47 p.m. and was greeted by staff. Licensee arrived at 03:30 p.m. Entrance interview conducted.

RECORD REVIEW: Beginning at 03:03 p.m. (client files) and 03:56 p.m. (staff files), LPA conducted a file review for all four (4) clients and for five (5) staff and observed the following: Staff have current first aid and training completed. Client records were reviewed for, but not limited to current Individual Programming Plan (IPP), medical records, P & I funds, admissions agreement, and consent forms. All records were in order. The last earthquake drill took place on 04/28/2026 and fire drill on 03/27/2026. Administrator’s Certificate is valid until 07/24/2027. The LPA observed documentation of the Infection Control Plan and obtained a copy of the Emergency and Disaster Plan.

The facility is vendored by Tri-Counties Regional Center. Beginning at 03:43 p.m., the LPA, along with Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 regulation. The following was observed:

Facility is a single-story residence that consists of four (4) bedrooms, three (3) for client use and one (1) for staff use and two (2) bathrooms.