Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Anca Campos and Lela Jackson, Direct Service Professionals (DSPs) and explained the purpose of the visit. The Administrator, Samuel Semenea arrived at 10:35am and assisted LPA with the inspection. The facility is licensed to care for six (6) Developmentally Disabled Adults, ages 18 through 59, ambulatory only. All clients residing at this facility receive case management services provided by South Centra l LA Regional Center . LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan and submitted to CCL. L iability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 06/14/2024 . A fire clearance for (6) clients is in place. Surety Bond (Summa Insurance Services) is in effect with bond amount of $1000 and expires on 07/15/2027. Fire Drill was last conducted on 10/28/2023.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains five (5) client bedrooms, two (2) full bathrooms, living room, kitchen, dining area, shaded backyard, and detached garage. Currently, there are six (6) clients living in the facility. Facility is a Level 4H. The interior and exterior physical plant was inspected. Client bedrooms were toured. E ach bedroom has a smoke detector, bed, linen, dresser, night stand, light, chair and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and has a shaded area and sitting area. Detached garage was inspected and there is an extra refrigerator/freezer to stock up additional food items. Kitchen knives, sharps objects are kept locked in a standing cabinet in the kitchen area and inaccessible to clients. The cleaning supplies and toxic substances are stored in a locked cabinet. The facility does not have a fireplace or open faced heater. There is one (1) fire extinguisher observed to be fully charged and serviced on 04/13/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facili ty. Water temperature readings measured at 115.1 deg F in bathroom #1 and 111.2 deg F in bathroom #2 and were within the required 105 - 120 degrees Fahrenheit. *****CONTINUED ON LIC809-C******