Facility Evaluation Report

Licensing Program Analyst (LPA) Mario Leon made an unannounced Required - 1 Year inspection to the above Adult Residential Facility (ARF). LPA Leon met with Diana Serpas, DSP (D1) and Lucresia Teodoro, DSP, and later by Debra J. Estrada, Co-Administrator. LPA Leon informed staff that the purpose of today's visit was to inspect the adult residential facilities' physical plant, review staff and client’s records.

The facility is licensed to serve four (4) developmentally disabled clients, of which two (2) may be non-ambulatory, aged 18-59 years. Two (2) of their clients are above the age of 59, with a hospice waiver for two (2).

LPA Leon verified current staff fingerprints that are cleared and associated to the facility. The ARF annual fees are current. The ARF is vendored by Harbor Regional Center (HRC).

LPA Leon and D1 toured the entire facility, inside and out. The Adult Residential Facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) bedrooms one (1) for staff , Two (2) bathrooms, family room/office/physical activity room, living room, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry room and attached garage. Documents are posted as mandated by the DPH and CCLD. Bedrooms one and three through five (1,3-5) are occupied by clients and contain the mandated furniture. Bedroom two (2) is a staff bedroom. The two (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at the facility and no bodies of water are present. Medications are centrally stored, locked and inaccessible to clients. Staff files are current, resident files are also current along with medications admissions record (MARs). The water temperature was measured at 117.6 F. A comfortable temperature is maintained in the facility, at 68.7 F. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to clients, 1 fire extinguisher located at the corner between the kitchen and living room is fully charged and the last fire drill was conducted on 2/17/2023. First Aid kits and supplies are complete and with manual. See LIC809-C