Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos made an unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with Licensee Yavette Wiley and Administrator Keith Cole . The purpose of the visit was discussed.

As a part of the inspection, LPA used the inspection tool, reviewed (2) client records, (2) staff files, and (1) client medications. Currently the facility has (2) clients of which (2) are ambulatory. The facility is vendorized through Harbor Regional Center. Facility is a one story family home with three (3) bedrooms. Each bed room is for one (1) client. There is (1) bathroom for client use. There is also a living room, a kitchen, central air and heating, a dining area, a shaded area located in the backyard. A detached car garage inaccessible to clients. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#3 are equipped with a (1) beds each, a dresser, lamp, chair, overhead lightning for each client. Bathroom #1 has a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations.

Infection control domain completed and there were no deficiencies. An exit interview was conducted and a copy of this report was provided to Licensee Yavette Wiley