Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Roxanne Young, Direct Service Professional (DSP) and explained the purpose of the visit. Administrator Celeste M. Orellana arrived at 10:25am and assisted LPA with the inspection. The facility is licensed to care for (4) Developmentally Disabled Adults, ages 18 through 59, ambulatory only. All clients residing at this facility receive case management services provided by Harbor Regional Center.

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

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located near the front door. The staff are wearing masks throughout their shift and disposable gloves are used to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Facility has COVID-19 signage posted throughout the facility. Staff are adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance for four (4) ambulatory clients is in place. Surety Bond (Western Surety Company) is in effect and in force with bond amount of $3000. Last Fire Drill was conducted on 03/24/2023.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains four (4) client bedrooms, two (2) full bathrooms, a family room, a living room, kitchen, dining area, backyard, detached office area and garage. Currently, there are four (4) clients living in the facility. Facility is Level 4I . The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, night stand, light, chair and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. However, Bathroom #1 has mold and mildew on the tiled walls and surrounding shower area. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and LPA observed old and ripped leather chair which will be picked up for disposal. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients. However, LPA observed a screwdriver in one of the kitchen drawers. The administrator took it and kept it in a locked cabinet immediately. There are two (2) fire extinguishers observed to be fully charged and both were last serviced on January 18, 2023. Smoke alarms and carbon monoxide were tes ted and operable. There are no firearms or weapons stored at the facility. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. At 11:00am, hot water supply measured 107.5 deg F in the kitchen, 109.4 deg F in bathroom #1, and 109.0 deg F in bathroom #2.