Facility Evaluation Report

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual visit. Upon arrival LPA met with staff. LPA observed three (3) three staff and three (3) clients in the home. Staff reported that there are three (3) clients in the home and one (1) client is attending day program. Reason for visit was stated and staff contacted Administrator. Facility infection control practices and procedures were reviewed with Administrator and staff.

The LPA toured the physical plant areas inside and outside with staff at approximately (approx.) 10am, to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher appeared fully charged and last serviced 02/15/2023. KITCHEN: Knives and cleaning supplies are stored in a locked cabinet under the sink. Kitchen appliances appeared to be in operable condition. Perishable and non-perishable food appeared sufficient. LPA observed food stored uncovered in the garage refrigerator. BEDROOMS: The LPA observed four single-occupancy client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom two (2) had a very strong bad odor. RESTROOMS: Restrooms are clean and sanitary and in operating condition. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. Required postings observed throughout the facility. The backyard patio is equipped with furniture for clients' use.

STAFF RECORDS : At approx. 11am: Staff files reviewed included but not limited to: training records, current first aid and CPR certifications. Staff present are fingerprinted, cleared and associated to this facility.

RESIDENT RECORDS: Reviewed at approx. 12pm: resident files included admission agreements, medical assessments, personal rights, consent forms, lists of personal property, and appraisals. One (1) out of four (4) clients files was missing an updated/current needs and services plan. According to administrator the appraisal was sent to family for signature. Administrator agreed to follow up and ensure it is signed and returned promptly. A technical violation was issued for this. (continue to LIC809c page)