Facility Evaluation Report

Lice nsing 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 Angie Murillo, Direct Support Professional I (DSP I) and explained the purpose of the visit. Licensee/Administrator Sandra Benson arrived shortly after and assisted LPA with the inspection. The facility is licensed to care for (4) Developmentally Disabled Adults, 2 ambulatory and 2 non-ambulatory, ages 18 through 59. All clients residing at this Specialized 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 maintained. The staff stated that they use disposable gloves to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan, but has not submitted the Infection Control Plan. LPA printed LIC9282 and provided it to the Licensee to complete. Bathrooms have hand washing signs, soap and paper towels. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains a total of (4) client bedrooms, (1) staff bedroom, (2) bathrooms, a living room, kitchen, dining area, backyard with shaded area, detached garage and 2 self standing sheds. Currently, there are four (4) clients living in the facility. 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. 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. Laundry area is in the detached garage. There are cameras installed in the back yard and the front yard only. There are (2) fire extinguishers newly purchased by the Licensee. 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.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has not been added to the Plan. Licensee agreed to submit the completed Infection Control Plan to CCL no later than Fri., 01/19/2024. A fire clearance is in place. 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 expires in Aug. 2024. Surety Bond in the amount of $3000 is in effect. L ast Fire Drill was conducted on 12/01/2023 and being conducted on a monthly basis.