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.

Infection Control: Facility has an updated infection control plan in place. Facility staff continue to practice hand washing with clients and disinfect the high touch service area every hour Facility has sufficient PPE supplies.

Physical Environment and Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes living room, dining area, kitchen, four client's bedrooms, three client's bathrooms, cleaning supplies closet and attached garage with washer and dryer. The four clients’ bedrooms have one bed, one chair, one drawer, one night stand, required furniture and beddings and sufficient lighting and closet space. The three client's bathrooms are clean, sanitary and in a good working condition. The hot water temperature tested in all three bathrooms were 109.0- and 113.1-degrees F. which is within the Title 22 regulation.

• 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.

Operational Requirement: The facility is licensed for 4 ambulatory of which 3 maybe non-ambulatory and currently all clients are ambulatory in the facility which is within the fire department requirement. The last fire drill was conducted on 3/26/2025. The last disaster drill was conducted on 3/26/2025. The clients can attend the community events if there's an opportunity or chances. The facility backyard has a covered patio with chairs and table for client to utilize the outdoor activity.

Staffing: The facility has sufficient staff to provide care and supervision to Clients. LPA reviewed the NOC shift staff and they have the required facility planned emergency procedure training.

Personal Records - Training: LPA inspected the Administrator and four (4) staff files and reviewed the required documents in their personnel files which included: personnel record, health screening, TB Test result, employee rights, required training hours, and valid first aid certificate. However, based on record review, Staff #3 (S3) and Staff #4 (S4’s) file did not have a health screening. The Administrator’s file did not have TB test results. The administrator is Cindy Garcia and her administrator certificate effective through 06/12/2026. The administrator has the required updated HIV training certificate. However, based on record review, administrator’s file did not have the required updated TB training certificate.

Clients Rights - Information: The facility has no client with any postural support. The facility does provide internet service for client and they do have at least one internet access device with video conferencing and client can communicate with their families, day program or primary physician if needed.

[Continue in LIC809-C]

Client Records - Incident Reports: All clients files are stored at the Staff office area nearing the dining table and LPA inspected all four (4) client's files and they have the required documents including: face sheet, admission agreement, functional capability assessment, appraisal/needs and services plan, preplacement appraisal, Updated Individual Program Plan (IPP), updated physician report, personal rights, ambulatory status and medication list. However, based on record review, Client #2 (C2) and Client #3 (C3) did not have updated medical assessment in file. LPA reviewed two (2) client's P&I Money in the facility.

Health-Related Services: The client's medication is stored and locked in the file cabinet near the kitchen. LPA inspected all three client's medication and they are all seemed accurate and up-to-dated. All of them have 30-day supply of medication. LPA inspected the first aid kit and they have all the required supplies in the kit.

Incidental Medical Services: Currently there's no client is on any restricted health condition plan and no client is with any prohibited heath condition.

Disaster Preparedness: Facility has an updated and complete Emergency Disaster Plan (LIC610D) in place. The facility has two alternative shelter location.

Emergency Intervention: All the facility staff are CPI trained and they all have updated CPI certificate in file but they haven't been used CPI /restrain on client.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator, Cindy Garcia.