Facility Evaluation Report

Licensing Program Analyst(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA Flores met with Massoumeh Ho and explained the reason for the visit. Administrator arrived 30 minutes later.

Facility is licensed to serve 4 clients age range 18 through 59, of which 4 may be non-ambulatory and/or bedridden. The single home is located in a residential facility and consist of 4 client bedrooms, 3 bathrooms, a kitchen, a living room, a dining room, an office, a laundry area, a back yard, a front yard, and an attach garage.

LPA Flores conducted a tour of the facility with Massoumeh Ho and observed the following:

Facility is clean and in good repair indoor and outdoor. Dining room and TV room have fireplaces which are cover with plexi-glass, and have sufficient seating area. Kitchen was observed clean, cleaning supplies were observed locked under the sink, sharps and knives were observed locked in a island cabinet, and medication was observed locked in two large pantry cabinets. Sufficient food supplies were observed for at least 2 days worth of perishables and 7 days of non-perishables. Each client's bedroom(4) has the required furniture, sufficient lighting, and bedding supplies. Each bathroom (3) is in working condition with grab bars, sufficient lighting, and water temperature was tested between 112.7-118.4 degrees F. which is within the required temperature 105-120 degrees F. Carbon monoxide/smoke detectors were observed, tested, and are in working condition. Fire extinguishers were observed and last checked on 6/14/23. Front yard and back yard were observed clean. Backyard has a pergola which provides a shaded seating area. Passageways were free of obstructions. Laundry room is located next to the kitchen, and garage is used to stored additional supplies and emergency food supplies.

LPA reviewed medication, files, and P&I money for 4 clients and 5 staff files. Infection control plan, emergency disaster plan last reviewed on 5/31/23. Last emergency drill was on 3/13/24.

No deficiencies noted during this visit. Exit interview was conducted and a copy of this report was provided.