Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control domain, food and medication review. LPA Flores met with Jana West administrator and explain the reason for the visit.

The facility is licensed for 6 Ambulatory Developmentally Disabled clients between the ages of 18-59. The facility is vendor through Frank D. Lanterman Regional Center as a level 3 home. Facility is a two story residential house with (4) client bedrooms, (2) bathrooms, staff room, living room, dining room, kitchen, front covered porch patio, back yard, laundry room, office, and storage room. No large bodies of water observed. Smoke detectors were tested and in working condition. Last fire drill was conducted on 12/6/21

LPA Flores conducted a tour of the facility with Jana West administrator and observed the following:

Living room and dinning are furnished and have sufficient lighting. No screening area upon entrance to the facility. Kitchen cabinet with medication was observed unlocked. Food supplies were observed sufficient for 2 days of perishables and 7 days of non-perishables. Cabinet with cleaning solutions was observed unlocked and left top hinge was missing screws. Bathroom #1's(B1) water temperature was tested at 132.5 degrees F. and bathroom #2(B2) water temperature was tested at 133.2 degrees F. which is not within the required 105 -120 degrees F. No paper towels or hand-washing sign were observed. All bedrooms have the required furniture, bedding, and sufficient lighting throughout the facility. Porch was observed to have a couch and covered outside sitting area. LPA reviewed medication for client #1(C1), and #2(C2) and files for C1, C2, and staff #1(S1) and #2(S2). Administrator's certification was observed #6022230735 and expires on 4/16/22. Facility keeps screening log for staff and residents. Staff have not been fit tested for N95. Signs were not observed throughout the facility. No emergency contact numbers observed.

Deficiencies have been noted on LIC 809D, a technical violation, and technical advisories have been provided.

Exit interview was conducted with Jana West administrator and a copy of this report, LIC 809D, technical violation/ advisories, and appeal rights were provided.