Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Octaviano Vasquez/Direct Support Professional I & II (DSP I & II) and explained the purpose of the visit. At 11:00am Edgardo Fermin/Administrator arrived at the facility and assisted LPA with the inspection. The facility is licensed to care for Developmentally Disabled Adults, ages 18 through 59, (4) ambulatory only, with restricted health conditions. 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. The Administrator stated that he has not submitted an Infection Control Plan. Facility does have COVID-19 signage still posted in the facility. Bathrooms have soap and paper towels. Staff are performing hand hygiene and adhering to infection control requirements.

Physical Plant and Environmental: The facility is a single storey home located in a residential neighborhood, contains a total of (4) client bedrooms and (3) full bathrooms, a living room/activity area, kitchen, dining area, den, office area by the kitchen, backyard, and detached 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, light, and sufficient closet space. LPA observed that window coverings such as blinds or curtains are missing on (3) out of (4) clients bedroom windows and some did not have window screens. L PA o bserved that bedroom #4 has an extra space divided by curtains containing a bed and bedroom furniture. Administrator stated it was being used as a staff room before. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Detached garage is inaccessible as it is cluttered and filled with different items such as used mattresses, large furniture and other discarded things. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked in a cabinet located in the kitchen and inaccessible to clients. There is one (1) fire extinguisher observed to be fully charged and was last serviced on 12/07/2022. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. There are no cameras in the facility. Water temperature readings measured at 109.5 deg F in bathroom #1, 114.9 deg F in bathroom #2 and 110.2 deg F in bathroom #3 which were within the required 105 - 120 degrees Fahrenheit.

Operational Requirements: A current Plan of Operation was reviewed. There is a Surety Bond Insurance in effect and valid through 4/18/2024. Administrator stated he will send a proof to CCL/LPA. Liability Insuranc e policy through Summa Insurance in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 3/19/2024. Fire clearance was approved for four (4) ambulatory clients only , with restricted health conditions. Fire and Disaster drills have not been conducted. Administrator showed a record of fire drill conducted on 8/2 019. Outdoor/backyard activity area provides a shaded area and furnished for outdoor use.