Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required unannounced annual inspection. LPA met with Administrator Edgar Fermin and explained the reason for the visit. The facility is licensed to serve (4) Ambulatory Adults, ages 18 through 59.

The facility is a single-story home located in a residential area in Bellflower, Ca. A tour of the facility includes: living room, dining area, kitchen, family room, 4 client bedrooms, 3 client bathrooms (one bath is inside client bedroom), laundry area, detached garage, front yard and back yard.

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

Infection Control: Facility maintains the required Infection Control Plan on site.

Physical Plant & Environment Safety: LPA toured facility, clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction (there is a broken wooden gate on side of the facility, exposing nails, TV issued for safety hazard) . No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested in the client bathrooms and was within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked cabinets and are inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. There were damaged/ripped window screens in kitchen and laundry room, missing window screen in bathroom #1 and missing window screen from Client #3 bedroom and 1 that does not fit window properly, sliding door screen in living room leading to back yard is also ripped, citation issued.

Operational Requirements & Staffing: Facility has an activity area furnished for outdoor use. There appears to be sufficient staffing at all times in the facility. (Continued on LIC809-C)