Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Staff#2 (S2) house manager Imelda Jonson and spoke with Administrator Carol Liess over the phone. The reason for the visit was explained to them.

The facility is licensed to serve nine (9) mentally disabled, ambulatory adults, ages 18-59. The facility is a two-story house, located in a residential area in Pasadena. On the first floor, it consisted of a living room, dining room, kitchen, office, TV room, a laundry area, one (1) live-in staff room and one (1) staff bathroom. On the second floor, it consists of five (5) client bedrooms and two (2) clients’ bathrooms. The facility has a front yard and back yard, a detached garage and two (2) shaded outdoor sitting area.

The following CARE tool domains were reviewed during this visit:

Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance.

Physical Plant & Environment Safety: Physical plant tour was conducted on both floors. Clients’ bedrooms were toured and observed to be in compliance. Smoke detectors and carbon monoxide detectors on the second floor were dual and those detectors were separate devices on the first floor. They were operable. Fire extinguishers were mounted on the wall at the kitchen and office. They were fully charged. Hygiene products were available for clients. (-Continued on LIC809-C)