Senior Care Records.

Facility Evaluation Report

Harriet House Annex, Pasadena06/24/2024Licence 198601506

Capacity6
Census6
Date signed06/26/2024 07:06:53 AM
The inspector’s account

Licensing Program Analyst (LPA) Daniel Konishi 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 Maria Reynaga, who is a Direct Support Professional at the facility and was granted access into the facility. Administrator, Monique Jordan arrived shortly thereafter and LPA explained the purpose of the visit. There are six (6) ambulatory who reside in the home. The facility is vendored through the Frank D. Lanterman Regional Center.

Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA observed that the facility had a completed infection control plan.

· LPA conducted a tour of the facility with Monique Jordan, the Administrator and observed the following:

The facility is a one story house located in a residential area and consists of four client bedrooms, two bathrooms, living room, dining room, kitchen/laundry room. There is a large front porch with sufficient shade and seating for client use and a back yard.

· All passageways, walkways, driveway, steps and patio are free from obstructions. The front, back and side areas of the house are free of hazards.

· Fire extinguisher was observed on hallway last reviewed 07/21/2023.

· Smoke/carbon monoxide detectors are tested and in working condition.

· Cleaning supplies are kept locked under kitchen sink away from food supplies.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction