The LPA 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. This is an Adult Residential Facility (ARF) with a fire clearance capacity of Six (6) clients. The facility is approved for Six (6) ambulatory clients between the ages of 18 through 59 years old.

KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in the kitchen are inaccessible to clients. This consists of a locked drawer, demonstrated to the LPA, which was observed by the LPA. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food. Additional perishable food items were maintained on a shelf and/or an extra freezer. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all clients living in the facility, and enough equipment for the storage, preparation, and service of food.

COMMON AREAS: At the time of the visit, living room and dining room were observed to be appropriately furnished, with all furniture in good condition. There is no fireplace in the living room or dining room areas. The facility maintained a comfortable temperature. Continued on 809-C

BACKYARD/LAUNDRY/GARAGE: The backyard of the facility is completely enclosed by a fence with self-closing latches and gates. There are 2 side gates from the facility which are delayed egress self-closing. The backyard of the facility is equipped with furniture for client use including shaded tables and chairs. There were no bodies of water noted. The backyard contains a locked shed with extra materials including furniture, decorations, and supplies that is inaccessible to the clients. There is a designated laundry room where cleaning products are stored, which is kept locked. The laundry room is accessible through the garage area of the facility, which was converted into an office/storage room area as per permits obtained through the County Building and Safety. There was emergency food and water in a storage room/area which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to clients are kept in areas inaccessible to clients. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport clients are in safe operating condition with appropriate insurance information.

BEDROOMS: The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are 6 bedrooms for non-ambulatory clients in the facility, and 1 bedroom for staff members. The bedrooms for clients are all individual units with 1 bed per room. Each closet in all the client rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any client. The client bedrooms are big enough for all beds, furniture, and any client assistive device such as a wheelchair or a walker. Each room has at the least a chair, nightstand, chest of drawers, and sufficient lighting.

RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There is 1 restroom in the hallway of the facility as well as 2 private restrooms in the client’s bedrooms. All restrooms inspected had assistive equipment for clients including grab bars and/or non-skid surfaces. Continued on 809-C

RECORDS: The facility keeps confidential storage of personnel records and client records on-site at the facility. Personnel records reviews were reviewed for, but not limited to Personnel records, Health assessments with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, Employee Rights, Criminal record Statements, Criminal record clearances, First aid/CPR certification that is not expired, and the appropriate training documentation. All staff member personnel records had the appropriate documentation with no expiration of any training. The Administrator has a current certificate for completion of the Adult Residential Facility (ARF) Administrator Certification Program that expires 01/21/2026. Client records were reviewed for Pre-Admission/Placement appraisals, Admission Agreements, Physicians Reports, Consent Forms, Personal Rights for Clients, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS)/Individual Program Plan (IPP), Client Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. All client records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. Client records also contained Tri-Counties information including Annual reports.

MEDICATIONS: The facility maintains a locked centralized storage area for client medications. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. The centralized storage area consists of a locked closet/room, only containing medications for the clients. The administrator/licensee demonstrated that the medications are locked and opened the area with a key for the LPA. The LPA audited the medications of the clients in care at the facility and found no inconsistencies or irregularities regarding medication.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

Continued on 809-C

No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.