Facility Evaluation Report

Licensing Program Analyst (LPA) Mayra Cota conducted an unannounced required annual visit. LPA met with Myla Chua, Direct Support Professional and explained the reason for the visit. Ruvy Pelesasa, Administrator arrived thereafter and assisted with the visit.

The facility is licensed to serve (4) non-ambulatory developmentally disabled adults ages 18 to 59 years old of which (2), may be bed-ridden/approved Hospice Waiver for (2). 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, CA.

During the visit, LPA toured the facility's indoor and outdoor environment, reviewed (4) client and (3) staff files and conducted medication review for (4) clients. The facility is a single-story house which consists of: receiving room, living room, dining area, kitchen/office area, (2) full bathrooms, (4) client bedrooms, laundry room, front and backyard, deck/patio area and detached garage.

During today’s visit, LPA observed the following:

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

Kitchen appliances are clean and were operating at the time of visit.

Sharps were observed locked in a cabinet under kitchen sink and inaccessible to clients.

Sufficient supply of 2 day perishable and 7 day non-perishable food was observed.

Menu is posted in the kitchen ***Continues on LIC 809C .