Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and LPA temperature was checked. LPA Bunker met Licensee Mark Thomas and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. There are currently zero (0), Westside Regional Center Adult Residential Care Facility (ARF) consumers in placement. The facility's annual fees are current.

The following 11 Domain will be observed and reviewed: Infection Control, Physical Plant & Environmental, Operational Requirements, Staffing, Personnel Records-Training, Client Rights-Information, Client Rights-Incident Reports, Food Service, Health-Related Services, Incidental Medical Services, and Disaster Preparedness "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

The facility is a single-family home located in a residential neighborhood. It consists of the following: Living room/office, kitchen, dining area, laundry area, 3 bedrooms, 1 1/2 bathrooms, patio shaded area, indoor and outdoor activity area, storage house in the backyard, and a detached garage. See continued LIC809-C on page 2