Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required-1 year inspection focusing on the Infection Control Domain. LPA Pena met with Administrator Herminia Dela Cruz and discussed the purpose of today's visit. This two story home is located in a residential neighborhood and has five (5) bedrooms of which four (4) are used as clients bedrooms and the 5 th room is the Administrator’s office/lounge, three (3) full bathrooms, a living room, family room, kitchen, dining area, office, backyard, and detached garage. The facility cares for intellectually disabled adults and is vendorized by Frank D. Lanterman Regional Center. Currently, there are four (4) ambulatory clients residing at the home. The Administrator's standard certificate is expiring 10/21/2022. Administrator stated that she has completed the required continuing education courses and mailed the completed certification on 9/16/2022. Annual fee is current and facility has submitted the Infection Control Plan to CCLD.

At 9:18am, LPA and the Administrator toured the facility. The following was observed/inspected:

§ COVID-19 signage was placed in several areas of the facility including the front entrance.

§ Facility maintained a 30-day supply of PPE to include masks, gowns, and face shields.

§ PPE supplies are stored in the storage room inside the home, and some are in the detached garage.

§ Staff wore face masks consistently throughout the shift.

§ All client bedrooms were toured. Each room contained required furniture including bed, dresser, night stand, lamp, chair, and closet. All beds contained the required linens including mattress cover, fitted sheet, flat sheet, blanket, and comforter.

§ Bathrooms are clean and operational and were observed to be within Title 22 regulations. Toilets and water faucets worked properly. Shower was free of mold/mildew and adequate lighting. Bathrooms contained supplies including liquid soap, toilet paper, and paper towels.