Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 10/14/2023. LPA Ramirez was met by Direct Support Staff (DSP) Sanyiza Busby and explained the purpose of the visit. The facility is licensed serve four (4) developmentally disabled clients 18-59 years old. The facility is a 4I level home. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020). All clients in the home receive services from Frank D. Lanterman Regional Center.

LPA OBSERVATIONS: Tour began at 09:25 am and was led by LPA Ramirez. The facility is a two story dwelling located in a residential area with four (4) client bedrooms, one (1) staff office, two (2) bathrooms, kitchen, dining room, living room, detached garage, front yard, and backyard.

Front Yard: LPA Ramirez observed front yard to be free of hazards.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to four (4) out of four (4) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to four (4) out of four (4) clients in care. LPA Ramirez observed a fully charger fire extinguisher nearby. Kitchen sink temperature was measured at 126.3 degrees F. LPA Ramirez will issue Type A deficiency.

Dining Room/Living room: Dining room was observed to contain one table with plenty of seating. Living room was observed with plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and handwashing etiquette in this area. LPA Ramirez observed nearby thermostat to read 69 degrees F.