Routine inspection·January 4, 2024

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff and explain the purpose of the visit. Administrator Ramiz Alchi approved for House Manager, Shameka Turner to complete this annual visit. The residence was set at 71 degrees F temperature and free of passageway obstructions inside and outside. LPA observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Two of the rooms are currently occupied. Hot water temperature was measured at 109.8 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the hallway closet. Cleaning supplies are kept locked in a cabinet inside the garage. Smoke and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers was service on 12/14/2023. Last drill completed on 12/27/23. Outdoor area was clean and free of obstruction. During the visit a file review was conducted for residents and staff files, refer to 809D for deficiencies. An exit interview was conducted, and a copy of this report was provided to House Manager, Shameka Turner whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 1/18/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage, LIC 8292, LIC 503 for caregiver staff.