Facility Evaluation Report

Licensing Program Analysts (LPA) Alberto Lopez conducted an unannounced site visit for the annual inspection. Upon arriving at the facility LPA met with Tayor Sutherland and Myrna Stevenson, Direct support staff and explained the purpose of the visit. Administrator was not available for the inspection due to illness. The facility is licensed to serve ambulatory only. Facility is a residential home to clients with Developmental Disabilities, Level 2. Administrator certificate expired on 01/08/22. Last fire drill was on 03/25/22

The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen, dining area, laundry area, 7 client bedrooms, 1 staff room, office, and an attached garage.

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.

· Facility does not have one designated isolation room as the resident have private rooms where they can isolate

· Seven client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Rooms were not equipped with alcohol-based hand sanitizer but available at facility.

· Seven (7) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were observed wearing masks.

· Clients were observed wearing masks and adhering to public health social distance guidelines.

· Sufficient supply of perishable food for 2 days & non-perishable foods for 7 days were observed.

· A posted Emergency Disaster Plan was observed at facility.

· Staff and resident files were not reviewed during today's visit.

Deficiencies cited per Title 22 Health and safety code, See 809D for details.

Exit interview was conducted with Myrna Stevenson, Direct support staff. A copy of