Facility Evaluation Report

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced visit at the facility for the purpose of conducting the required annual inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA Gonzalez met with Assistant Administrator Rana Chapkhaneh and explained the purpose for the visit.

The facility is licensed to serve (4) developmentally disabled adults ages 18-59 years old, all non-ambulatory. Facility is operating within the approved capacity. Currently, there are four (4) clients in placement, there are no clients who have a restricted health care condition. All clients residing at this facility receive case management services provided by Harbor 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 Services, Disaster Preparedness, and Emergency Intervention.

During the visit LPA observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has sufficient PPE supplies, has an Infection Control Plan and Mitigation Plan. Facility has COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap and paper towels. Per Facility Assistant Administrator four (4) clients have COVID-19 vaccines including boosters. Per Facility Assistant Administrator all staff also have the COVID-19 vaccines including boosters. Facility Administrator is adhering to infection control requirements.

Refer to LIC 809C for continuation of report