Facility Evaluation Report

Licensing Program Analyst (LPA) Tao, conducted an unannounced annual inspection. The facility is licensed to serve four (4) Developmentally Disabled clients, Ambulatory only, from ages 18-59. Client census is three (3). LPA was allowed entry by the Facility Licensee/Administrator. East LA Regional Center provides case management service to all clients residing in this home. The annual fee is paid. LPA discussed the purpose of today's visit.

During the visit, the following domain of the new inspection tool was used: infection control domain;

a tour of the facility conducted; food supply was reviewed; and medications were reviewed.

LPA toured the facility inside and outside. This is a single-story house consisted of three (3) client bedrooms, two (2) bathrooms, laundry room, living room, kitchen, dining area, activity room, and indoor/outdoor activity areas. Backyard, front yard and hallway area are free of obstruction. Backyard has shaded area and free of debris/ hazard.

The kitchen is clean. Facility has maintained the required two (2) days perishable and seven (7) days non- perishable. All burners and stove tops are in working condition. Client bedrooms were checked and closet/drawer space to accommodate each client is available. Lamps/lights for each room were available to ensure the safety and comfort of all persons in the facility. Adequate linen and personal hygiene supply are observed. Bathrooms are clean and operational.

LPA also inspected facility common areas including the kitchen, living room, and dining area. Administrator tested the Smoke Detectors and carbon monoxide detectors. They were operational. Fire drill was conducted on 8/2/2021. Fire extinguisher was fully charged and the last service was on 7/21/21. The first aid kit was fully stocked with a manual.