Facility Evaluation Report

Licensing Program Analysts (LPAs) Tena Herrera and Gabriela Castro conducted the required annual inspection. LPAs arrived unannounced and met with Dalisay Lazo - House Manager and explained the purpose for today’s visit. The facility is licensed to serve (3) Non-Ambulatory Clients ages 18-50, and have a Hospice waiver for (1). All clients are serviced through Harbor Regional Center.

The facility is a single-story home located in a residential area in Bellflower, Ca. A tour of the facility includes: 3 Bedrooms, 2 Bathrooms, Living Room, Kitchen, Dining Area, Detached Garage with Laundry and Storage, Front Yard and Back Yard.

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

Infection Control: The facility maintains the required Infection Control Plan.

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. 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 cabinet in the garage 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.

Operational Requirements: Staff have proper training to meet the needs of the clients in care. Facility has an activity area furnished for outdoor use. (Continued on 809-C)