Starting at 9:55am, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The LPA observed the kitchen/food area at approximately 10:05am. The kitchen appliances appeared to be clean and in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food; properly stored. Refrigerator and dry food pantry were checked for proper labels and expiration dates. Knives and sharps were observed in a locked closet by the main entrance. Cleaning supplies and toxins were also observed in a locked closet by the main entrance.

BEDROOMS: There are four (4) bedrooms for client use and one (1) bedroom designated for staff only. The LPA observed all client bedrooms to be properly furnished with a bed, appropriate and adequate bedding, nightstand, chair, and sufficient lighting. There is a closet in the hallway with additional clean linens and towels, and client personal hygiene items.

Report Continued on LIC 809C...

COMMON AREAS: The LPA observed the living room and dining room area to be furnished appropriately, and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed required postings throughout the common space. There is a working telephone on premises. Facility has an adequate amount of emergency food and water. At 10:09am, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. No obstructions or hazards were observed inside or out.

GARAGE: The garage is attached to the facility. Washer and dryer were observed. Staff assist clients with all laundry needs.

OUTDOOR / BACKYARD: There is a shaded area in the backyard with appropriate furniture for client use. The exterior passageways were clean and clear of any obstructions at the time of the visit. The LPA observed two (2) self-latching gates for emergency use. No bodies of water noted at the time of the visit.

RECORD REVIEW: The LPA reviewed four (4) Client Records and five (5) Personnel Records including the Administrator’s file starting at 10:20am.

Client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan/IPP. All files were complete.

Report Continued on LIC 809C...

Administrator’s Certificate is active until 08/05/2026.

The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 4i home.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Fire extinguisher was observed to be fully charged and serviced on 04/18/2024. Emergency disaster drills are conducted quarterly; last drill was conducted on 03/05/2025.

MEDICATION REVIEW: The LPA conducted a medication review at approximately 12:55pm. Medications are centrally stored in a locked closet by the main entrance. All medications including PRNs were labeled, stored, and locked inaccessible to client in care. Medications appear to be given as prescribed at the time of the visit.

Exit interview conducted. Copy of the report was provided.