Facility Evaluation Report

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Jonathan Withers, Direct Support Staff, and the reason for the visit was explained. Patricia Winbush, Direct Support Staff, arrived thereafter and continued to facilitate the visit.

The facility is licensed to serve (6) ambulatory only adults age 18 to 59. There are currently (5) clients living in the facility. The facility is operating within the scope of its license. Clients in care receive services through the South-Central Regional Center.

The two-story home is in a residential area of Carson and it consists of:

First floor - living room, den, dining room, kitchen with dining area, half bathroom, attached garage with laundry area, front and backyard.

Second floor - (3) client bedrooms, (1) live-in staff room, (1) staff break room and (1.5) bathrooms.

The following was observed during today’s visit:

Facility is clean and walkways and staircases are free of debris and obstructions. Furniture throughout the facility is in good repair. There is sufficient seating in the den, living room and dining areas for clients. Bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space.

Kitchen appliances are clean and were operating at the time of visit. Sharps and cleaning supplies are kept locked and inaccessible to clients. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed. Overflow refrigerator was also observed clean and well stocked.

Bathrooms were inspected and were observed clean and sanitary. Shower in main bathroom has grab-bars and anti-slip mats. Water temperature was tested and measured within the required 105 - 120 degrees F. Sufficient personal hygiene supplies for residents are kept in the garage storage cabinets. ***Continues on LIC 809-C***