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 Katherine Jimenez, Direct Service Professional I (DSPI) and Ralph Cabagnot Direct Service Professional I (DSPI) and explained the purpose of the visit. LPA spoke with the weekend Administrator, Anna Marie Tomilloso on the phone and stated that she will be arriving in the facility. At 10:25am, Administrator Anna Marie Tomilloso arrived. At 10:45am, the Licensee/Administrator Merci Gonzales arrived and assisted LPA with the inspection.The facility is licensed to care for four (4) Developmentally Disabled Adults, ages 18 through 59, non ambulatory only, and has a hospice waiver for 1. 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. DSP Ralph Cabagnot did not screen the LPA immediately upon entry, but eventually screened LPA minutes after. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Facility has COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap and paper towels. 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 and submitted to CCL. Liability Insurance policy 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 03/31/2024. A fire clearance for (4) clients is i n place . Surety Bond (Summa Insurance Services) is in effect with bond amount of $2000 and expires on 04/24/2027. Fire Drill was last conducted on 09/04/2023 and Earthquake/Emergency Drill on 09/05/2023.

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, living room, kitchen, dining area, office area next to the kitchen, backyard, and attached garage. Currently, there are four (4) clients living in the facility. Facility is a Specialized Home. 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. Exit doo rs are free of any obstruction and there are no pools or large bodies of water. LPA observed a small puddle of water in the side yard and Administrator swept it to clear the area. Backy ard was inspected and has a shaded area and sitting area. Attached garage was inspected and there is an extra refrigerator/freezer to stock up additional food items. Kitchen knives, sharps objects, are kept in a medium size tool box inside the kitchen cabinet, however there is no lock, which are accessible to clients. The cleaning supplies and toxic substances are stored in a cabinet under the sink which is also kept unlocked and are accessible to clients. The facility has two (2) fireplaces which are both screened and inaccessible to clients. There is one (1) fire extinguisher observed to be fully charged and purchased on 1/15/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature's initial readings were not within the required 105-120 degrees Fahrenheit. Administrator adjusted the hot water temperature setting, and the 2nd reading measured 110.4 deg F in bathroom #1, and 114.8 deg F in bathroom #2 which are within Title 22 Regulations requirement.