Facility Evaluation Report

Licensing Program Analyst (LPA) KaSandra Lopez. The LPA initially met with the caregiver and advised them of the reason for today's inspection. There are currently two caregivers and five clients living in the home. Licensee Representative Maria Miranda was contacted and arrived at the facility at during the inspection. The facility is vendored by Tri Counties Regional Center as a level 3 home.

The LPA, along with the Licensee Representative, 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 were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored. Items that could pose a danger including sharp items and cleaning supplies were secured in locked drawers. Facility has a three day supply of emergency food and water. Medications are stored in a locked drawer in the kitchen.

COMMON SPACES: In the common areas, furniture, walls, and flooring were clean and in good condition at the time of the inspection. All indoor and outdoor passages were free of obstruction. The fire extinguisher was fully charged and last serviced on 01/27/2023. At 12:39 PM, the carbon monoxide detector and smoke detectors in the common areas and bedrooms were tested and were operational. The backyard has outdoor seating for client use.

RESTROOMS: The facility has two common restroom for client use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. At 12:33 PM, the hot water temperature was measured in the hallway common restroom and it measured at 110.3 degree F.

BEDROOMS: There are three client bedrooms and one staff bedroom. The LPA observed the client bedrooms to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report continued on LIC 809-C.