Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Annual Required 1-Year Visit with the primary focus on infection control measures and the use of the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms, and LPA's temperature was checked. LPA Bunker met with Tiffany Fleming and explained the purpose of today's annual inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There are currently three (3) Westside Regional Center consumers in placement. The facility's annual fees are up to date.

The following 12 Domains will be observed and reviewed: Infection Control, Physical Plant & Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Client Rights-Information, Client Records-Incident Reports, Food Service, Health-Related Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention. "LPA Bunker 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."

LPA Bunker and Tiffany Fleming toured the facility. The facility is a two-story single-family home located in a residential neighborhood. The facility consists of a living room, dining room, kitchen, laundry room, den, 4 bedrooms, 3 bathrooms, a family room, and an office. The facility has a two (2) car detached garage and an indoor/outdoor activity area, which features a shaded area furnished with outdoor patio furniture, including tables and chairs. The facility has three (3) exits, located in the living room, kitchen, and den. Bedrooms #1-4 are designated as the client's bedrooms.