Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Micaella Cisneros (Caregiver) and explained the purpose for today’s visit, shortly after Assistant Administrator Maria Tavarez arrived to assist with visit.

The facility is licensed to serve 4 Non-Ambulatory Developmentally Disabled Residents ages 60 and over, and is approved for 1 Hospice Resident. The facility currently has 1 ambulatory and 3 non-ambulatory residents, which are serviced through Harbor Regional Center.

The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: 4 Resident Bedrooms, 2 Bathrooms, 1 Staff Room, Living Room, Dining Area, Kitchen, attached garage with laundry, front yard and back yard.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following:

Infection Control: Facility maintains the required Infection Control Plan.

Operational Requirements: The facility maintains the required liability insurance.

Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. (Continued on LIC809-C)