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25 | Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by Licensees, Robert Clemente and Louie Clemente and explain the purpose of the visit.
The residence was set at 72 degrees F temperature and free of passageway obstructions inside and outside. LPA observed four bedrooms in the residence. Three rooms are currently occupied, and the fourth bedroom did not have furniture set up. Client#1 refused entry to this LPA to their bedroom. Three of the rooms were found to be clean.
Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked and stored in the kitchen area. PPE is stored in the garage. Smoke detectors and carbon monoxide were checked and operating. Last drill was completed on 12/09/23. Fire extinguisher was last serviced on 2/27/2023. There is outdoor seating.
An exit interview was conducted, and a copy of this report was provided to Licensee, Robert Clemente whose signatures confirms receipt.
During the visit a file review was conducted for residents and staff files.
LPA requested the following updated forms faxed to CCLD by 02/07/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Emergency Disaster Plan (LIC610E), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.
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