Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Jorge Lizarraga/Direct Support Professional (DSP) and explained the purpose of today's visit. At 11:30am, Rana Chapkahneh/Admistrator arrived and assisted LPA with the inspection. 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 at the entrance, but LPA did not observe PPE supplies. T he facility has submitted an Infection Control Plan . The facility has also submitted a COVID-19 Mitigation Plan. Facility does not have COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single storey home located in a residential neighborhood. Facility has (3) client bedrooms and (2) full bathrooms, kitchen, living room, dining area, backyard, and detached garage. It is licensed for Developmentally Disabled adults 18 to 59 years old, and (2) non ambulatory only, with restricted health conditions. Currently, there are four (4) clients living in the facility. All clients residing at this facility receive case management services provided by Harbor Regional Center. Facility is Level 4I. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. LPA observed that a bed with full rails in bedroom #3. Administrator stated that the facility accepted a new client on Fri., 8/11/2023 to provide temporary respite care for Client #4 (C4). 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 . Additional PPE supplies are also stored in the detached garage. Kitchen knives, sharps objects, cleaning sup plies and toxic substances are locked i n a cabinet by the laundry area and inaccessible to clients. There is (1) fire extinguisher observed mounted on the kitchen wall and was last serviced on 7/16/2021. 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 within the required 105 - 120 degrees Fahrenheit. Hot water supply measured 114.deg F in bathroom #1 and 110.6 deg F in bathroom #2.

Operational Requirements: A Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Administrator will send a copy of the Infection Contro l Plan to LPA. Administrator cannot locate and provide a copy of the Liability Insurance and Surety bond to LPA. Administrator agreed to send it to LPA and ensure that both insurance are valid. Care and supervision to meet the residents needs was observed.