Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required 1-yr inspection. LPA was allowed entry by Emmeline Baldoza, DIrect Support Professional I (DSP I) and explained the purpose of the visit. At 1:00pm, Francisca Chamu-Nestor, Administrator, arrived and assisted LPA with the inspection. The facility is a Specialized home and licensed for (5) non-ambulatory clients age 18 through 59. All clients residing at this facility receive case management services provided by Frank D. Lanterman 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 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 and submitted to CCL. 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 will expire on 7/13/2024. Surety Bond (Western Surety Company)is in effect and in force with bond amount of $10,000. The fire clearance is approved for (5) non-ambulatory clients. Fire drill was last conducted on 08/13/2023 and Earthquake drill was last conducted on 7/16/2023.

Physical Plant & Environment Safety: This facility consists of (5) client bedrooms and (1) staff room, (2) client bathrooms, (1) staff bathroom, living room, relaxation/lounge, kitchen, dining area, backyard patio area, detached office and detached garage. Smoke alarms and carbon monoxide were tested and operable. Total of (4) fire extinguishers appeared to be full and were last serviced on 10/20/2022. 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 114.8 deg F in bathroom #1, 115.3 deg F in bathroom #2 and 112.1 deg F in bathroom #3, which were all within Title 22 Regulations. The home has 5 ambulatory clients, none have a restricted health care condition and 2 clients are between the ages of 18-59. 3 clients are over 60 and facility has age exemption for 2.

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