Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with DSP Juvy Biala and explained the reason of the visit. Shortly after, the administrator in training Christeann Santos and Jeff Jin arrived and assisted with the visit. The facility is approved for serve Developmentally Disabled Adults, age range 18 through 59, 3 Non ambulatory and hospice waiver for 1. The facility is licensed as a Level 4I home vendored by Harbor Regional Center.

The following twelve (12) tool domains were observed and reviewed: Infection Control, Physical Plant/Environmental Safety, Operational Requirements, Staffing, Personal Records-Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incidental Medical Services, Disaster Preparedness and Emergency Intervention.

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Plant and Environmental Safety: The facility is a single story house and the facility includes three clients bedrooms, two clients bathrooms, kitchen, dining area, living room and detached garage with a laundry room. Each client has one bed, one chair, one night stand, required furniture and beddings and sufficient lighting and closet space. The two client bathrooms are clean, sanitary and in a good working condition. The hot water temperature in two bathrooms were tested between 110.3 and 112.8 degrees F. which are within the Title 22 regulation. All the appliances in the kitchen and living room are working probably. The sharp knives and utensils are stored and locked in the kitchen drawer. The chemicals and all cleaning supplies are stored and locked under the sink. The extra linen are stored in the hallway cabinet. The extra personal hygiene products are stored in the kitchen drawer near the staff office. LPA also inspected the smoke detectors and they are working well.(See LIC 809C for continuation)