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 screened and met by Arleen Santos/ Direct Service Professional (DSP) and explained the purpose of the visit. Administrator Christal Clarke and Licensee Jeremy Miller will not be able to come to the facility. 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 and PPE supplies located near the front door. There is no staff present at the facility. The Licensee will submit the COVID-19 Mitigation Plan and Infection Control Plan to CCL. Facility has COVID-19 signage posted by the entrance.

Physical Plant/Environment Safety: The facility is a 2 storey home located in a corner lot of a residential neighborhood, contains a total of (3) bedrooms, (3) full bathrooms, a living room/activity area, kitchen, dining area, attached garage and front/side yard.The facility is licensed to care for (4) Developmentally Disabled Adults, ages 18 through 59, ambulatory only. There are no clients living in the facility at the moment. All future clients to reside at this facility will receive case management services provided by Harbor Regional Center. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair, nigh stand and sufficient closet space. Bathroom in the Master's bedroom did not have supplies like toilet paper, soap and paper towel. (1) of the bathrooms has non-skid materials but did not contain hygiene supplies including liquid soap, paper towel, and toilet paper in one of the bathrooms. There is a phone at the facility but call could go through, out of service. There is a phone at the facility but call could not go through, it was out of service. xit doors are free of any obstruction and there are no pools or large bodies of water. Front and side yards were inspected, and the front yard has a shaded area, sitting area and designated one corner for smoking. Attached garage was inspected and LPA observed chemicals such as paints, pain thinners, disinfectants, cleaning supplies on the floor and not kept in a safe secure, locked location. There is an extra refrigerator/freezer to stock up additional food items next to the laundry area. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients. There are (2) fire extinguishers observed, one in the kitchen and one in the upstairs hallway, but there was no indication when they were purchased or when they were serviced. Licensee purchased a new fire extinguisher and provided LPA the receipt and photo of the fire extinguisher by text messaging. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water t emperature readings measured within the required 105 - 120 deg F. Hot water supply measured 111.8 deg F in the kitchen, 110.8 deg F in bathroom #1, 112.6 deg F in bathroom #2 and 113.1 deg F in bathroom #3.

Operational Requirements: A current Plan of Operation was unavailable and LPA was not able to review. Licensee stated that he will submit the Infection Control Plan to LPA/CCL. A fire clearance for (4) clients is in place and was granted on 4/01/2022.