Facility Evaluation Report

A Required One (1) year visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with Co-Administrator Bernard Isiko and explained the reason for the visit. LPA observed that the three (3) residents were at the facility during visit and the other was at the Day program. This facility is a North Los Angeles Regional Center (NLARC) vendored facility Level III.

A tour of the physical plant was conducted at 12:44 PM and the following was noted:

The front main door is the only entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted approved Mitigation and Infection Plan. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the backyard and the office converted garage. The facility has sufficient stock of PPE in the garage.

The facility is a single storey house and has four (4) bedrooms and two (2) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use. There is no body water in the facility. The facility is fire cleared for four (4) ambulatory residents.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature was measured at 118.2°F and within the required range. (continued to LIC 809-C)