Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was screened and allowed entry by Lucita Guillermo/Direct Support Professional(DSP). LPA explained the purpose of today's visit. At 11:00am, Administrator Johnette Bellosillo arrived and assisted LPA with the inspection.

The facility is licensed to serve 3 Ambulatory Developmentally Disabled Adults, Restricted Health Conditions ages 18 through 59. Current census is (3) ambulatory. 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: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has sufficient PPE supplies. Facility has an Infection Control Plan and Mitigation 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.

Physical Plant & Environment Safety: This facility consists of (3) bedrooms (2) full bathrooms, living/activity room, kitchen, dining area, and detached garage. Smoke alarms were tested and operable. Fire extinguisher appeared to be full and was last serviced on 04/04/2023. Carbon monoxide tested and operable. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. There are no firearms or weapons stored at the facility. Hot water supply measured 115.8* in the kitchen, 74.8* in bathroom #1 , and 116.3* in bathroom #2.

Operational Requirements: The fire clearance is approved for (3) ambulatory, restricted condition clients. Last Fire Drill was conducted on 01/21/2023.

Staffing : There is sufficient staffing at the facility. The Administrator, Johnette Bellosillo is still waiting for her curent certificate. Her Administrator certificate (#6023643735) expired on 01/23/2023. Renewal along with CEU's were submitted on 12/10/2022. Administrator's HIV/AIDS Training Certificate shows completion on 6/24/2022. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Refer to LIC 809C for the continuation of this report.