Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted required the annual inspection, LPA met Administrator Swarna Amarsinghe and explained reason for visit. The facility is licensed to serve 48 Ambulatory Only, Mentally Disabled Adults ages 18-59.

The facility is located in Artesia, CA and consists of 6 separate buildings.

Building 1 includes a living room, dining room, office, kitchen, six bedrooms (shared) and two bathrooms. Building 2 includes 2 bedrooms (shared) and 2 bathrooms. Building 3 includes 1 bedroom (shared), 1 bathroom, laundry room and pantry room. Building 4 includes 2 bedrooms and 1 bathroom. Building 5/ Medication room includes 10 bedrooms (shared) and 5 bathrooms. Building 6 /Trailer includes 3 bedrooms, 2 bathrooms, a living room/lounge, and a kitchen (without stove).

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility maintains the required Infection Control Plan.

Operational Requirements: The facility maintains the required fire clearance and plan of operation on file and as multiple outdoor shaded areas for the clients.

Staffing : There appears to be sufficient staffing at all times in the facility.

Personnel Records-Training : Administrator Manel "Swarna" Amarasinghe has a valid administrator certificate that expires on 3/24/28. During today’s visit LPA observed 6 staff files each were fingerprint cleared and had valid first-aid certificates, however, LPA observed the following deficiency: Health screening for S3 is blank with no physician signature and Health screening for S6 does not have staffs name which makes it difficult to confirm if health screening is for that particular staff, citation issued.

Client Rights-Information: Facility provides clients with telephone and internet. (Continued on LIC809C)