Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Noel De Los Reyes who is a caregiver at the facility and was granted access into the facility. Administrator Ronald Dino arrived shortly thereafter. There are three (3) ambulatory developmentally disabled clients who reside in the home. The facility is vendored through 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 and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA asked administrator to send a completed infection control plan to LPA within 7 days.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of three (3) non-ambulatory developmentally disabled clients between the ages of 18-59, and one (1) hospice waiver. It consists of three (3) individual client bedrooms, a living room, dining room, a kitchen, one (1) shared client bathrooms (R1) which had a hot water temperature measured at 105.9 Degrees F, and a second private restroom (R2) which measured at 107.4 Degrees F, a main hallway which contained the facility’s laundry machines, a front and back patio area, and an attached garage which serves as a storage area for the facility.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Fire alarm system is operational.