Facility Evaluation Report

Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced Annual Required Visit on 07/30/2024. LPA were met by Staff #1 (S1) and explained the purpose of the visit. Administrator Maria Theresa Rualo arrived shortly after and assisted in tour of facility. The facility has a fire clearance approved for four (4) ambulatory of which two (2) may be non-ambulatory clients. All clients receive services from Harbor Regional Center. LPAs requested and obtained a copy of Personnel Report, and Resident Roster.

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 observed that the facility has an infection control plan in place.

· LPA conducted a tour of the facility with S1 and observed the following: The facility is a single-story building in a residential area, with a kitchen, dining room, living room, family room, 4 client bedrooms, 2 bathrooms, backyard with shaded area and a garage. · All passageways, walkways, driveway, steps and patio are free from obstructions. The front, back and side areas of the house are free of hazards.

· Hallway closet: Contained plenty of linens, towels, PPE’s, and hygiene products.

· Fireplace is secured, closed, and inaccessible to clients.