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 screened and met by Arleen Santos/ Direct Service Professional (DSP) and explained the purpose of the visit. Administrator Rommel Gonzales arrived shortly thereafter and assisted LPA with the inspection. The facility is licensed to care for (4) Developmentally Disabled Adults, ages 18 through 59, ( 3) ambulatory and (1) non ambulatory only . 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 and PPE supplies 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. 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. A fire clearance for (4) clients is in place. Surety Bond (Summa Insurance Services) is in effect and in force with bond amount of $2000. The insurance will expire on 07/17/2023. Last Fire Drill was conducted on 01/01/2023.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains a total of (6) bedrooms, (4) of which are client bedrooms and (2) are staff bedrooms, three (3) full bathrooms, a living room/activity area, kitchen, dining area, backyard, and attached garage. Currently, there are four (4) clients living in the facility . Facility is Level 4I. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Client bedrooms do not have a night stand. 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. Backyard 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, cleaning supplies and toxic substances are locked and inaccessible to clients. There is a fire extinguisher observed to be fully charged and was last serviced on July 13, 2022. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Hot water supply measured 116.5 deg F in the kitchen, 115.7 in bathroom #1, and 118.9 in bathroom #2.