Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Denise Gutierrez a DSP staff member. Administrator Tranae Gatlin arrived shortly after. There are two (2) ambulatory and one (1) non-ambulatory developmentally disabled clients who reside in the home. The facility is an Adult Residential Facility (ARF) vendored by Harbor Regional Center.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station at the entrance of the facility. Each individual client bedroom may be designated COVID-19 isolation room if needed. The facility does not currently have an Infection Control Plan on file, however LPA explained which LIC form needs to be completed, and administrator Gatlin advised she will either fax or email the document to LPA Zaragoza within 7 days.

· The facility is a single-story home located in a residential neighborhood that is licensed for three (3) non-ambulatory clients. It consists of 3 client bedrooms, a living room, dining room, a medication storage room which also contains the staff/resident files, a kitchen, 2 (two) bathrooms of which the non-private restroom R#1 measured at 113.1 degrees F and private restroom R#2 Measured 114.4 degrees F, backyard patio area, and an attached garage.