Routine inspection·May 8, 2025

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced annual required visit with the primary focus on infection control measures and using the new CARE Inspection Tool. LPA Bunker met with House Manager Rickie Vernal and Staff Member Kian Pascual to explain the purpose of today's annual inspection. There are currently five residents in placement. The facility's annual fees are current. The following 12 Domains will be observed and reviewed: Infection Control, Operational Requirements, Physical Plant & Environmental Safety, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records/Incident Reports, Disaster Preparedness, and Residents with Special Health Needs. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." Mr. Vernal and LPA Bunker toured the facility. The facility is a single-story family home located in a residential neighborhood. Which consists of a living room, dining area, kitchen, 3 bedrooms, 2 bathrooms, laundry area in the garage, attached garage, and an indoor/outdoor activity area. A shaded area furnished with outdoor patio furniture, including tables and chairs. Bedrooms #1,3, 4, and 5 are designated as the resident's bedrooms. Bedroom #2 is designated for the living staff. See continued LIC809-C page 2 Continued LIC802-C page 2 Documents have been posted, as mandated, on the bulletin board in the entrance hallway. The following Title 22 regulated areas were audited and found to be in compliance: The facility telephones are working. Bedrooms: All bedrooms meet the required standards for furniture, safety, privacy, and comfort. The facility has an adequate supply of linen. Bathrooms: The bathrooms are clean and operational, and residents are provided with the necessary personal accommodations with non-skid surface mats ensuring safety and privacy. Kitchen and Food Service: The kitchen is adequately equipped for food preparation and service. A review of the food service revealed an ample supply of perishable and nonperishable food, stored appropriately. Medication Storage and Management: Medications are centrally stored in a locked cabinet in the living room with up-to-date records, ensuring proper storage and documentation. Common Areas: The Living room, dining room, and common areas are well-maintained, free of potential hazards, and meet the cleanliness standards necessary for the safety and well-being of residents. Safety Equipment and Measures: The facility is equipped with a fully stocked first aid kit with manual, functional smoke and carbon monoxide detectors, and the fire extinguishers are in compliance and have been properly charged. The hot water temperature is measured at 111 degrees and is maintained within the standard range of 105-120 degrees Fahrenheit. Emergency Preparedness: All exit doors are in compliance, the resident's bedroom windows are equipped with sliding window locks without thumbscrews, and the facility conducted a fire drill on April 07, 2025. Environmental Safety: The yard is free from debris and hazards, trash cans are covered, and no firearms or bodies of water are present on the premises. Hazardous items are kept inaccessible to residents. Staff Training: Staff members have received training on reporting dependent adult and elder abuse. Administrative Compliance: The Administrator Certificate courses that have been completed are currently valid. Compliance with HIV/TB requirements has also been verified. LPA Bunker provided staff with a copy of the facility evaluation reports. There were no deficiencies cited. An exit interview was conducted.