Facility Evaluation Report
LPA Ashley Calderon visited the facility for an unannounced 1 year required annual inspection.LPA upon arrival met caregiver, Jennifer Ong. Shortly after LPA met with Administrator Archimedes "Archi" Lopez and Assistant Administrator Mirafy Lopez and discussed the purposed for the visit.
The facility has an Adult Residential Facility licensed to serve a total of four (4) non ambulatory developmentally disabled adults between the ages of 18-59, one (1) can be bedridden. This facility is approved for one (1) hospice waiver.
Currently there is (1) client in place. Clients are placed through vendorized agency: Harbor Regional Center.
LPA Calderon used CARE inspection tool to conduct the visit and conducted staff interviews and client interview attempt. The facility is a single story facility containing: living room, kitchen, dining room, four bedrooms, (no staff bedroom), two bathrooms, laundry area (in garage) , backyard patio and a attached two car garage,
The following was observed, reviewed and inspected:
LPA requested, received and reviewed (1) client medications with Medication Administration Record (MAR), all medications have labels and physician's orders, all medication were noted on the MAR. LPA requested, received and reviewed the client files, all client files contained the required documents including: IPP, Face Sheet/Identification Page, Physician's Reports with TB Test Results. LPA requested, received and reviewed (4) staff files, all staff files contained the required documents including: Health Screening with TB Test Results, First Aid and all staff were clear.
LPA alongside with Administrator toured and inspected the physical plant:
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction