Routine inspection·February 6, 2024

LPA Audrey Jeung toured facility and grounds of this facility that serves elderly developmentally disabled persons. There are 3 shared client bedrooms, activity room, 2 full bathrooms, kitchen and living/dining room on ground floor. There is a bathroom and 2 staff rooms on 2nd floor; one room has 4 beds and the other has 2 beds. The washer and dryer are located in attached 1-car garage and extra supplies are stored in storage shed in backyard. There are no accessible bodies of water or fire safety hazards observed. Toxins, medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is complete. Client files are reviewed, and medications are recorded on Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff training records. Pureza Ganio and Antolin Ucol are certified RCFE administrators that oversee facility operations. Night staff is awake. As per legislation, effective 1/1/2015, the following information is posted: 1) PUB474, pertaining to resident councils, per AB1572; 2) text of Health and Safety Code 1569.269 AND CCR Title 22 Section 87468 (Personal Rights form LIC613C), per AB2171; 3) CCLD Hotline information, per SB895. The following licensing forms are requested to be completed and submitted to CCLD BY 2/20/24: - Administrative Organization (LIC309) - Designation of Administrative Responsibility (LIC308) - Affidavit regarding Client Cash REsources (LIC400) - Emergency Disaster Plan (LIC610-E signed and dated on page 9) - Proof of control of property (current signed lease) Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Also, see Advisory Notes issued--5 pages.