Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with DSP staff Odin Serrano and explained the purpose of the visit. Administrator Mary Gonzalez arrived shortly after. There are four (4) level 4i developmentally disabled clients over the age of 60. The facility is serviced by Harbor Regional Center. The facility is a single story home located in a residential neighborhood that is licensed for 4 non-ambulatory clients, of which 3 have restricted health conditions. It consists of 4 bedrooms, 2 bathrooms, 1 office, living room, TV/activity room, dining room, kitchen, outdoor covered patio, and attached garage with laundry area. The last fire drill was conducted on 12/22/2021. Administrator certificate expires 12/29/2022.

COVID-19 Infection Control screening and signs were observed in the entrance, common areas, hallways, and bathrooms. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. No health and safety issues were observed.

Facility has an approved COVID-19 Mitigation Plan.

Each resident room has been designated as a COVID-19 solation room if needed.

Four (4) centrally stored resident medication records were reviewed.

Staff was observed wearing a surgical mask.

Clients in care do not wear masks because it is not tolerated due to cognitive impairment.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Administrator Mary Gonzalez. A copy of the report was issued.