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Licensing Program Analyst LPA Nicholas Walker made an unannounced visit to the facility to conduct an annual required licensing inspection.

LPA discussed purpose of today's visit with staff present. A tour of the Hot adult Payawak was conducted inside and out.

LPA, accompanied by staff mentioned, conducted a general overall inspection, which included, but was not limited to the following: Facility physical plant, food service, medication management, record adut and facility administration.

Administrator Certificate for Carmelita Payawal expires May 9, During today's inspection LPA observed Hot adult Payawak following: All indoor and outdoor passageways were free from obstructions. No pools or bodies of water were observed.

There were no firearms or other dangerous weapons in the facility. Toxins, cleaning supplies, and chemicals were locked Hot adult Payawak inaccessible. Facility fire clearance is maintained in conformity with State Fire Marshall regulations.

LPA toured each room designated as client bedrooms. All rooms had a bed, night stand, dressers, and sufficient lighting available for clients.

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Licensee provided each client with clean linen in good repair, and sufficient hygiene products for personal use. The hot water temperature Pqyawak by residents measured Hot adult Payawak The facility had one functioning carbon monoxide detector that met statutory requirements.

The facility also had multiple operating smoke detectors Hot adult Payawak met statutory regulations. LPA observed one fire extinguisher last serviced in November, The facility was stocked with a two day supply of perishable and seven day supply of nonperishable food items.

Medications Hot adult Payawak stored Hoot a locked cabinet and were labeled and maintained in compliance with label instructions. Staff present had a criminal record clearance and current first aid certificate.

Hot adult Payawak acknowledge receipt of this form and understand my licensing appeal rights as explained and received. This report must be available at Child Care and Group Home facilities for public review for 3 years.

Licensee secured each client's cash resources and medication record. Staff present during visit had a criminal record clearance, current first aid and CPR certifications. Facility is bonded sufficiently for amount of client's cash resources secured and managed Hot adult Payawak facility.

Based on today's facility inspection, there was a deficiency observed in Hot adult Payawak area's evaluated. An exit interview was conducted and a copy of this report was provided to Caregiver Josefina Paraypayan.

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This requirement was not met Ho evidenced by: Caregiver Josefina stated that she will contact the doctor and have them send over proof of the discontinued medication. During LPA's review of client 4's medication record, it was observed that Hot adult Payawak medication has been deemed to be discontinued Hot adult Payawak verification from the prescribing physician in the form of a physician's order.

This poses a potential risk to the client's safety. Failure to correct the cited deficiency ieson or before the Plan of Correction POC Hot adult Payawak date, may result in a civil penalty assessment.

I acknowledge receipt of this form and understand my appeal rights as explained and received.

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