Facility Evaluation Report

On 03/16/22 Licensing Program Analyst (LPA) Jade Jordan conducted an Unannounced visit to conduct an Annual inspection with an emphasis on infection control. LPA was met by Debra Davenport Supervisor.

Upon entry LPA was screened for Covid-19 Symptoms, and temperature was manually taken.

The facility is family home, located on a residential street. The facility is licensed for (6) developmentally disabled adults, of which (2) can be Non-Ambulatory. All clients are Vendored through West side Regional Center.

The facility interior includes (3) client bedrooms, (2) bathrooms, living room/activity room, dining area, kitchen with washer and dryer and a detached garage used for storage. All bedrooms had the required furnishings, including 1 Bed with fitted sheet, flat sheet, comforter, 1 Chair, adequate lighting, dresser/drawer space and closet. All bathrooms are sanitary, free of mold/mildew with working toilets, faucets, and showers. Hallways, and walk ways are free of obstruction and debris.

LPA observed an ample supply of Perishable/Non Perishable items.

Sharps, Toxins, and Medication were locked and inaccessible to clients in care.

LPA reviewed 2 resident files, and 1 Mars. All Records were up to date, and retained

the required documentation, including health screenings, personal rights. .