A Happy Place Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Herman Javier for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 10:00 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms for residents and two (02) bathrooms. The facility is fire cleared for five (05) non-ambulatory and one (01) bedridden resident. The facility is currently occupying three (03) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 109.9°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Duguma conducted an announced Pre-licensing visit at 10:00 AM and met with administrator/licensee, Herman Javier. LPA conducted an entrance interview with the Administrator. With the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. Fire Clearance is approved for five (05) non-ambulatory and one (01) bedridden resident. Facility has four (04) bedrooms and two (02) bathrooms for residents. Resident bathrooms have properly installed grab bars and shower has non-skid mats. All residents’ bedrooms are adequately furnished. The linens are stored in the storage space located in the hallway. Towels and washcloths are not shared. The common areas are appropriately furnished. The living room and dining room are neat and clean. The LPA observed entertainment equipment and games for activities. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. LPA inspected the kitchen and observed the stove and refrigerator to be clean and working. Facility has sufficient quantity and variety of nonperishable food supply. Nonperishable foods are stored in the cupboards and additional items in the garage. Sharps observed to be stored in a locked kitchen drawer. All garbage containers observed to have lids. (CONT. on LIC 809-C) Smoke and carbon monoxide detectors were checked and function properly. There is a fully charged fire extinguishers located in the dining area last purchased 04/19/2024. LPA advised the Administrator to retain the receipt of the fire extinguisher identifying the purchase date. Hot water temperature measured at 116.3ºF during the visit. First-aid kit is complete. LPA observed a washer and dryer in the garage. All chemicals, additional personal hygiene items and other toxins are stored in the locked cabinet in the garage. At the time of this visit the physical plant is meeting Title 22 requirements. The Component III was completed with the LPA. No health and safety hazard were noted during this visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Aug 14, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Jun 21, 2024