Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and was greeted by Leonardo Gonzales (caregiver) who allowed entrance to the facility, shortly after Derry Sandajan (House Manager) arrived to assist with the visit. The facility is licensed to serve 6 Ambulatory only clients ages 18 to 59 years old. There are currently 4 clients serviced through South Central Los Angeles Regional Center at the facility.

The facility is a single-story home located in a residential area in Downey, CA. A tour of the facility includes: dining area, office area, kitchen, living room, 3 client bedrooms (one shared room), 2 bathrooms (1 client-1 staff), attached garage, front yard, backyard, and a locked toolshed.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has sufficient PPE supplies and an Infection Control Plan posted by the entrance.

Physical Plant & Environment Safety: Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. Bathrooms are clean and operational. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested in client bathroom and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and are inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguisher was observed and is fully charged.

Operational Requirements: Facility has an activity area furnished for outdoor use.

Staffing : There appears to be sufficient staffing at all times in the facility. (Continued on LIC809-C)