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 Bunker was properly screened for COVID-19 symptoms and LPA temperature was checked. LPA Bunker met the Licensee/Administrator Vanessa Lee 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 one (1), Westside Regional Center Adult Residential Care Facility (ARF) consumers in placement. The facility's annual fees are current.

The following Domains will be observed and reviewed: Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Clients Rights-Information, Clients 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.

Licensee Ms. Lee and LPA Bunker made a complete tour of the entire facility inside and outside grounds. The facility is a single-story family home located in a residential neighborhood. The facility consisted of the following: Living room, dining room, kitchen, four (4) bedrooms, two (2) bathrooms, laundry closet, indoor/outdoor activity area, covered patio shaded area, detached two (2) car garage, front and back yard landscape is in good condition at the time of visit. Bedrooms #1-4 are designated as client's bedrooms. See continued LIC809-C on page 2