Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Juan Cruz and explained the purpose of today’s visit. The facility is licensed for ambulatory only residents 18-59 years old. The facility formerly known as "Ramona Guest Home - Bellflower" had a change of management company and is pending a change of ownership.

The facility is located in Bellflower, CA. A tour of the facility includes: First building : 3 client bedrooms (1 with a private bath), lobby area, Administrator office and Medication room. Middle Building : 2 single bedrooms with private bath, 2 double bedrooms with a shared (jack and jill) bath. Rear Building : (this building is under construction in the large dining area-there are no clients residing in this area), temporary dining/tv area with restroom, employee restroom, handicapped restroom, 9 client bedrooms, kitchen, dining/activity room, laundry room, electrical panel/storage room.

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

Infection Control: Facility maintains the required Infection Control Plan.

Physical Plant & Environment Safety: Smoke detectors/carbon monoxide detectors/fire extinguishers are operable and in compliance. Clients’ bedrooms/bathrooms were checked and closet/drawer space to accommodate each client comfortably was available. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the clients bathrooms and measured within the required range of 105-120 degrees F. Storage areas for cleaning solutions, toxins, knives, and hazardous items were observed to be locked area inaccessible to clients. Facility has telephone service on premises. There is a sprinkler system approved by the fire marshal throughout the facility (within each building).

Operational Requirements: There is an approved fire clearance on file and the facility ensures that clients are given the opportunity to participate in community activities and there is a shaded area that is equipped for outdoor use. (continued on LIC809-C)