Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong and Benette Pena conducted an annual required visit. LPAs met with Licensee administrator Sandra Empson and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed client and staff files. Facility has submitted a mitigation plan and approved on 5/7/21.

The facility is a single story house and located in a residential neighborhood area. The facility includes, three clients bedroom, one client bathroom, licensee and husband bedroom and bathroom, living room, kitchen, den, laundry room and a detached garage. All 3 client bedrooms were toured. Bedroom#1 has one bed, one dresser, one night stand, required furniture and linen and sufficient closet space and lighting. Bedroom#2 and #3 has two beds, two drawers, required furniture and linen and sufficient closet space and lighting. Client's bathroom was toured. The bathroom is clean, sanitary and in working condition. The hot water temperature in bathrooms and kitchen was tested between 118.2 and 120 degrees which is within Title 22 regulation. The refrigerator in the kitchen and garage has sufficient for two days perishable and 7 days non-perishable food storage. All the kitchen appliances are clean and working properly. The knives and sharp utensils are locked in the kitchen cabinet and inaccessible to clients. The common areas such as living room and dining area are clean and have the required furniture. The toxic and cleaning supplies are stored in the locked cabinet in the laundry room and is inaccessible to clients. The front and back yard are maintained well and back yard has a shaded area with table and chairs.

LPA's reviewed 3 client files to confirm emergency contact is updated. LPA also reviewed two staff files and they are all fingerprint cleared and updated health screening on file. LPA reviewed 3 clients' medications and all 3 clients medication are updated and seemed accurate.