Facility Evaluation Report

Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required - 1 Year inspection at the facility today. This home is vendored by Tri-Counties Regional Center as a level 4-I home for six residents. Licensee Representative Joemar Ong arrived shortly after the inspection began.

This annual had a specific emphasis on infection control practices and procedures. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN : The kitchen and food storage areas in the garage were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored in the kitchen and garage. Cleaning supplies are stored in locked cabinets in the garage. Knives and items that could pose a danger are in locked cabinets and drawers.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. All indoor and outdoor passages were free of obstruction. At the time of the visit, living room and dining room furniture was observed to be in good condition. The fire extinguisher was fully charged and last serviced 02/08/2022. The carbon monoxide detector and smoke detectors in the home and bedrooms were tested and were operational. Medications and facility records are centrally stored and in a locked cabinet in the living room. The backyard has covered seating for resident use.

BEDROOMS: There are four resident bedrooms. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.