Facility Evaluation Report

On 12/30/2024 at 1:48 pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Dontri Sangchampa Direct Support Professional and the purpose of today’s visit was explained. The facility is licensed to operate for (4) non-ambulatory and is approved for Hospice Waiver for (1) clients. Currently, the home has (4) clients: (2) ambulatory and (2) non-ambulatory. The clients are South Central Los Angeles Regional Center clients. The facility has an annual fee with the balance of $454.00 due on January 31, 2025. LPA provided pin #296580 to the facility with the option to make facility payment online.

The facility is a one story home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 2 common bathrooms, staff office, living room, kitchen, dining room, attached garage which houses the washer and dryer and an outdoor shaded area.

LPA reviewed (4) Client Medication Administration Records and did not observed any discrepancies for the MAR at the time of visit. The last fire drill was conducted 10/22/2024.

At 1:55 pm LPA and Dontri Sangchampa (DSP)toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. 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 (in kitchen 114.2 F, in Bathroom #1-112.5F & in Bathroom #2 105.8F).