Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the infection control domain. LPA met with lead staff, Lina Cuentos, and explained the purpose of the visit.

The facility is approved for four (4) non-ambulatory developmentally disabled adults, ages 18 - 59. There are currently 4 clients residing at the home and are placed by the Regional Centers.

LPA Chan toured the facility and observed the following:

* There are 5 bedrooms (4 Client bedrooms and 1 bedroom for live-in staff), 2 bathrooms, living room, dining area, kitchen, office space, and an attached garage. The backyard has a shaded area. There are no obstructions to the passageways and no bodies of water.

* The facility has proper Coronavirus (COVID-19) signage at the main entrance and around the home. Hand washing signs are posted in each of the bathrooms and sink.

* Staff are screening all visitors and documenting their temperature. Staff and clients' temperature are also taken daily and documented.

* Sufficient PPE supplies such as N95, surgical masks, gloves, and face shields are stored at the facility.

* The client bedrooms are equipped with the required furniture and are well maintained.

* The smoke detectors and carbon monoxide detector were tested and operable.

* Food supplies for 2 day perishable and a week of non-perishable were observed.

* Knives and sharps are stored and locked under the kitchen sink.

* Cleaning supplies are stored and locked with the washer and dryer located in the backyard.

* Medications are centrally stored and locked. LPA reviewed all 4 medications and did not observe any deficiencies.

* All staff on duty were wearing face masks.

* Per lead staff, they are still following the COVID-19 guidance and also clean and disinfect on every shift.

No deficiencies were issued today. Exit interview held and a copy of this report was provided.