Facility Evaluation Report

On 03/29/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with caregiver Kristina Morales and the purpose of today’s visit was explained. The facility is licensed to serve three (3) non- ambulatory residents ages 18 through 59. The residents are Harbor Regional Center Department of Mental Health residents.

The facility is a single-story home and consists of the following: three (3) client bedrooms, two (2) bathrooms one (1) of which is for residents and one (1) is for visitors and staff, staff working area, living room, kitchen, laundry area, dining room, attached garage which houses an additional refrigerator for extra food storage and an outdoor shaded area.

LPA conducted a records review of three (3) residents records, zero (0) staff records as they were unavailable during visit, three (3) residents Personal & Incidental Records and reviewed the facility disaster plan. The Last fire drill was in December 2022. All resident records were complete. LPA reviewed (3) Client Medication Administration Records and did not observed any discrepancies at the time of visit.

All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed, walls and floors were clean and in good repair, bed linens, comforters and bath towels were fully stocked. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105-120F, bathroom #1 was 114.3F & bathroom #2 was 112.3F, kitchen sink was 117.5F

Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide and smoke detectors are interconnected and operable. Two (2) fire extinguishers were fully charged, one (1) located and mounted in the entry way and the second (2) in the kitchen, toxins and knifes