Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced, required one-year annual visit with a primary focus on Infection Control measures and the use of the new CARE Inspection Tool. Upon arrival, LPA Bunker conducted a risk assessment. Based on the findings, the facility is clear of COVID-19 infection. LPA Bunker met with Assistant Director Blanca Macias, who explained the purpose of today's Annual Inspection.

LPA verified that the facility has an approved mitigation plan report and infection control plan. There are currently zero (0) Adult Residential Care Facility (ARF) – Mentally Disabled residents in placement. The facility’s annual fees are current. The facility is in the process of a change of ownership, and the new owners have submitted a new application.

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."

The facility is a single-family home located in a residential neighborhood. LPA Bunker and Ms. Macias toured the facility, which consisted of the following: Living room, kitchen, family room, breakfast nook, dining room, office, 4 bedrooms, 2 1/2 bathrooms, activity room, laundry room, shaded patio area, storage room, detached garage, and indoor/outdoor activity areas. The front and back yard landscape is in good condition at the time of the visit. See continued LIC809-C on page 2