Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection on 2/20/25. LPA arrived unannounced and met with Staff who allowed entry. The administrator, Christopher Bundalian, arrived shortly after to assist with the visit. The facility is licensed for four (4) clients, ages 18 to 59, of which (1) may be non-ambulatory and (1) bedridden in room #1. There is an approved hospice waiver for 1 individual and a dementia plan was submitted. The facility is vendorized by the Harbor Regional Center as a level 4I.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility has 4 client bedrooms, 1 storage room, 3 bathrooms (2 in private rooms and 1 communal), living room, open kitchen and dining area, and an attached garage. The washer and dryer are located in the garage. There are sufficient food supplies of perishable and non-perishable items. The kitchen is kept clean. Knives are locked under the kitchen sink. There are operable smoke and carbon monoxide detectors placed throughout the house. Extra hygiene and cleaning supplies are locked in the garage storage cabinets. The hot water was measured within the required range of 105-120 degrees F.

Medications are centrally stored. LPA reviewed 3 client medications and did not observe any discrepancies. The client files have the required documentation such as Admission Agreement, Emergency and Identification form, consent forms, current Individual Program Plan, physician's report with TB results, and property valuable form. P&I ledgers are completed for each client. LPA reviewed 3 staff files and each contains the personnel record, health screening and TB results. Staff are receiving annual training and have current CPR & First Aid certificates. Administrator's certificate expires on 8/3/26.

The Emergency and Disaster plan is reviewed by the administrator annually. Disaster drills are being done at least quarterly.

There were no deficiencies issued today. An exit interview was held and a copy of this report was given to the administrator.