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 screened and met by Smyrna Dojcinoviv, Licensee and Ronaldo Yuson, Co-Administrator and explained the purpose of the visit. The facility is licensed to care for five (5) bedridden adults . All clients residing at this facility receive case management services provided by South Central Los Angeles 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 are wearing masks throughout their shift and disposable gloves are used to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan. Facility has COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap and paper towels. Staff are adhering to infection control requirements. The Administrator is responsible for communicating with emergency personnel in the facility.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains a total of (5) bedrooms, (2) bathrooms, a living room, kitchen, dining area, backyard, and detached garage/storage. Currently, there are five (5) clients living in the facility. The interior and exterior physical plant was inspected. Licensee is not operating beyond the conditions and limitations specified on the license, including the capacity. All clients are protected against hazards. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Client bedrooms have the required furnishings. 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 stores additional PPEs and other medical equipment. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked in the kitchen drawer and inaccessible to clients. There are (2) fire extinguishers observed to be fully charged and was last serviced on 1/30/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Hot water supply measured 116.6 deg F in bathroom #1, and 115.3 in bathroom #2.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. An annual fire inspection is conducted by USA Fire & Safety Inc., last inspection held on 3/12/2023. A fire clearance for (5) clients is in place. Liability Insurance poli cy 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 2/17/2024. Surety Bond is in effect and in force with bond amount of $5000. The insurance will expire on 5/20/2024. La st Fire Drill was conducted on 09/12/2023. Emergency and Disaster Plan drill was last conducted on 9/18/2023.