Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Michelle Dominguez and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed staff and client files. The facility is licensed to serve four (4) developmentally disabled adults between the ages of 18-59. LPA observed the three (3) residents at the time of this visit.

There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.

LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA observed that the facility does not have a swimming pool or other bodies of water. All indoor and outdoor passageways are free of obstruction.

The facility consisting of: four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, laundry room, detached garage with an upstairs storage room is located in the rear of the property with entry from the alley, with a patio area in the backyard, an outdoor shaded area. Facility was free of odor. LPA observed sufficie nt furniture and lighting throughout the facility. Facility has a fire sprinkle system. Smoke and carbon detectors were in good repair. The fire extinguishers observed to be fully charged. The common areas such as living room and dining room are clean and have the required furniture.