Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Passion Letuli, Back-up Administrator and explained the purpose of the visit. The facility is licensed to care for (6) Developmentally Disabled Adults, ages 18-59, of which (2) clients may be non ambulatory. Facility is level 4I Specialized. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Bathrooms have hand washing signs, soap and paper towels. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a 2-story home located in a residential neighborhood, contains a total of (4) client bedrooms, (2) full bathrooms, a living room, office, kitchen, dining area, backyard, and a detached garage. The (4) clients living in the facility receive case management services provided by Frank D. Lanterman Regional Center. The interior and exterior physical plant was inspected. Client bedrooms were toured . Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficie nt closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap and toilet paper. Exit doors are free of any obstruction and there are n o pools or large bodies of water. Backyard was inspected and there were no debris or any obstructions. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients. There are (2) fire extinguishers , one in each floor, which were last serviced on 09/10/2024. Laundry area is in the detached garage as well as additional refrigerator and freezer. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. The facility has a video camera monitor system in all common areas . Water temperature readings measured within the required 105 - 120 degrees Fahrenheit, bathroom #1 read at 110.2 deg F and bathroom #2 read at 108.1 deg F.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been submitted to CCL. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurr ence and $3,000,000.00 in the total annual aggregate is valid and will expire on 08/05/2025. Surety Bond is valid with bond amount of $2000. Last fire drill was conducted on 09/07/2024 and earthq uake drill was conducted on 08/13/2024. Both emergency drills are conducted on a monthly basis.