Facility Evaluation Report

On 10/31/2025 at 10:32am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Von'Eric Johnson, Administrator and the purpose of today’s visit was explained. The facility is licensed to operate for (1) ambulatory, (2) non-ambulatory that serve developmentally disabled adults ages 18 through 59. The facility has an pending Age Waiver for (1) clients. Currently, the home has (3) clients. The clients are Harbor Regional Center clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices.

The facility has a current administrator certificate (#7015335735) for Von'Eric Johnson valid from 03/07/2024 - 03/06/2026. The facility fees are current. The facility has liability insurance with AIG Specialty Insurance Copany (NAIC# 26883) with each occurrence at $4,000,000 and general aggregate at $4,000,000 (policy #3752210) effective date 10/01/2025 - 10/01/2026. The facility fees are current.

The facility is a 1 story home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 2 common bathrooms, staff office, living room, kitchen, dining room, attached garage which houses the washer and dryer and an outdoor shaded area.

Between the hours 11:00am - 1:45pm of LPA conducted a records review of (3) client records, (3) staff records and reviewed the facility disaster plan. The last fire drill was conducted on 09/18/2025. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (3) Client Medication Administration Records and did not observed any discrepancies at the time of visit.