Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit. LPA met with staff Monaliza Quan and explained the purpose of the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit. The following domains were completed:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an Infection Control Plan in place. Staff are performing hand hygiene and adhering to infection control practices.

Operational Requirements: A current Plan of Operation was reviewed. Fire clearance was approved for six (6) ambulatory, of which two (2) may be non ambulatory. Fire and Disaster Drill was conducted 4/03/2024. Outdoor/backyard activity area provides a shaded area and furnished for outdoor use.

Physical Plant and Environmental: The facility is a single storey home located in a residential neighborhood, contains a total of four (4) client bedrooms, one (1) staff bedroom, one (1) office, two (2) full bathrooms, (1/2) bathroom, a living room, kitchen, dining area, backyard, and attached garage. Currently, there are five (5) clients living in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Laundry area is in the attached garage. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients in care. One (1) fire extinguisher observed to be fully charged and serviced. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. There are no cameras in the facility. Water temperature readings measured within Title 22 requirements.

Incidental Medical Services: There are no clients with restricted or prohibited health condition.