Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Sister Yuhan (Mi Ja Ko) who is the administrator of the facility and was granted access to it. There are four (4) ambulatory developmentally disabled clients who reside in the home. The facility is vendored through the Frank D. Lanterman Regional Center.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA asked the administrator to submit a completed infection control plan to LPA within 7 days.

· The facility is a two-story home located in a residential neighborhood that is licensed for a capacity of six (6) developmentally disabled clients between the ages of 18-59, two (2) of which can be non-ambulatory. It consists of three (3) shared client bedrooms, a living room, dining room, a kitchen, an activity room, a guest room, one (1) shared client bathroom which had a hot water temperature reading of 105.2 Degrees F, and a separate Restroom in the Guest Room which measured at 106.1 Degrees F, a front and back patio area which included the facility’s laundry machines, an office, an indoor laundry area, a warehouse closet that housed the facility’s cleaning solution, and multiple staff rooms and a bathroom as well which were all located on the upper floor of the facility.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water.