Facility Evaluation Report

This report was amended to obtain Facility Representative signature on all pages.

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year inspection at the facility today. LPA met with licensee Joseph Johnson and explained the reason for the visit. This home is vendored by Tri-Counties Regional Center as a level two home. Administrator Rhetta Wilson arrived at 10:28 a.m.

The LPA toured the physical plant areas inside and outside with the Licensee 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 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. The facility has a supply of emergency food and water. Sharp items were observed to be locked in a closet and inaccessible to clients.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and 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 on 03/05/2025. The carbon monoxide detector and smoke detectors were tested and operational. Cleaning supplies were observed to be locked in the laundry room and inaccessible to clients in care. The backyard has covered seating for client use. No bodies of water were observed.

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

REPORT WILL CONTINUE ON LIC809-C (2ND PAGE).