The following domains were reviewed during today's annual required visit which included: infection control, physical plant and environmental, operational requirements, staffing, personnel records-training, client rights-information, client records-incident reports, food service, health related services, incidental medical services, disaster preparedness and emergency intervention.

1. Infection Control: The facility has an approved infection control plan and sufficient PPE supplies in place. The facility staff continue to practice hand washing and using gloves in the facility. Staff would clean and disinfect once a day or more often for high touched surfaces area.

2. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes dining area, living room, kitchen, four clients’ bedrooms and two client's bathrooms and a detached garage. Each client's bedroom has one bed, chair, drawer, nightstand and required furniture and beddings and sufficient lighting and closet space. The two client's bathrooms are clean, sanitary and in a good working condition. The two client's bathrooms hot water temperature were tested from 105.9 degrees F to 108.1 degrees F which are within the Title 22 regulations. All the kitchen appliances are working properly. All the sharp knives are stored and locked in the cabinet next to the dining table.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

The cleaning supplies are stored and locked in the cabinet next to bathroom #2. The extra personal hygiene products are stored and locked in the cabinet next to the bathroom and the hallway cabinet. The extra linen and towels are stored in the hallway cabinet. LPA inspected the carbon monoxide detectors and they are all interconnected and they are working well. The facility has a telephone services on the premises. The facility has a hallway night and staff will turn on the light during the nighttime so client can access the non-private bathroom. The passageway, walkway and patio are free of obstruction. Outdoor patio has a shaded area for clients. Fire extinguisher is in the kitchen and fully charged and last inspected on 05/09/2024.

3. Operational Requirements: The facility is approved for four ambulatory clients and currently all four clients in the facility are ambulatory. The facility has a covered patio with table and chairs for client to utilize the outdoor activity. The facility also would let client to participate or attend community activities if there's a chance or opportunity.

4. Staffing: The facility has a sufficient staff to provide care and supervision to clients in care. LPA reviewed the NOC shift staff and had the required facility emergency procedure training.

5. Personal Records-Training: The facility staff files are stored and locked in the black cabinet next to the dining table. All the staff in the facility are over 18 years old, background check cleared and associated with the facility. LPA reviewed four staff files and they all have the required documents including health screening, TB Test, Employee Rights, First Aid Certificate and CPI Certificate and required training hours. The administrator is John Wilson-Ekaun and his administrator certificate expire on 8/8/2025 and the administrator also has the valid HIV and TB certificate.

6. Client's Rights-Information: Currently there's no client in the facility required any postural support. Also, the facility has at least one internet access device with internet service for clients to use.

7. Food service: Currently there's no client in the facility required modified diet. The facility has sufficient food supply for two days perishable and seven days non- perishable. All the food in the facility are stored properly. The facility would provide at least three meals and snacks per day to client.

10. Incidental Medical Services: Currently there's no client in the facility has any restricted health condition or prohibited health condition.

11. Disaster Preparedness: The facility has an updated emergency disaster plan dated on 5/23/2024 and the last fire and disaster drill was conducted on 2/18/2025. All the staff also received annual emergency disaster training. The facility also has three temporary shelter location in place.

12. Emergency Intervention: The facility does not use restraint with clients but they will use Emergency Intervention Techniques and LPA reviewed the staff files are CPI trained.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit Interview conducted and a copy of the report was provided to the Administrator, John Wilson-Ekaun.