Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with DSP Vanessa Lopez and explained reason for visit. Administrator Marisela Romero was notified by telephone and stated she was away on emergency and did not have a facility designee. Facility is approved for: age range 18 through 59. Six (6) ambulatory residents in room 1,2, and 3. Room 4 for staff use only. Clients receive services though West Side Regional Center. The facility is a one-story structure located in a residential neighborhood. The facility consists of (3) client bedrooms, (1) office, (2) bathrooms, living room, kitchen, dining area, patio, garage used for storage and laundry area.

LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in a hallway closet. Smoke detectors/carbon monoxide detectors were observed in each room and throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers which is kept in the kitchen. Cleaning supplies and toxic substances are inaccessible to clients locked under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 45 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Sharps are locked in a box and placed in drawer in kitchen. There are no firearms or weapons stored at the facility. The hot water faucet in sink in bathroom #1 did not work. The hot water in bathroom #2 was measured at 104.5 TV was issued. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. LPA was unable to review Administrator, staff, and client files due to staff having no access to documents and Administrator being away and not having an authorized designee. LPA requested a copy of infection control plan and emergency drills conducted at facility. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all clients, and they are being administered as prescribed by the physician.

Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D, and appeal rights were provided to Vanessa Lopez.