Facility Evaluation Report

Licensing Program Analysts (LPAs), Mayra Cota and Blanca Gonzalez, conducted an unannounced required annual visit. LPAs met with Charlene Borla, Direct Support Staff and explained the reason for the visit and she assisted LPAs with the tour of the facility. Ma. Flora De Guzman, Administrator, arrived shortly after.

The facility is licensed to serve three (3) ambulatory and one (1) non-ambulatory (Hospice waiver for one), developmentally disabled adults ages 18 to 59. The facility is operating within the scope of its license. Clients receive services through the Harbor Regional Center. The facility is in a residential area of Lakewood.

During the visit, LPAs toured the facility's indoor and outdoor environment, reviewed 4 client and 5 staff files, and conducted medication review. The facility is a single-story house which consists of living room/office area, dining room, kitchen, 3 full bathrooms, 4 bedrooms, laundry room, front and backyard, and attached garage.

During today’s visit, LPAs observed the following:

Living room furniture is clean and in good repair. There is sufficient seating for clients in care.

The home has a fireplace in the living room which was observed to be covered at the time of visit..

Kitchen appliances are clean and working properly.

Cleaning supplies and toxins were observed locked under kitchen sink and are inaccessible to clients.

Sharps are kept in a kitchen cabinet and were observed locked and inaccessible to clients.