Facility Evaluation Report

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced site visit for the Required - 1 Year inspection. Today's visit is a continuation to the Required - 1 Year inspection conducted on 10/28/2021. Upon arriving at the facility, LPA met with Staff / Maria Rivera and was later joined by the Administrator / Maria Carlos who assisted with the visit. The facility is licensed to serve six (6) Developmentally Disabled Clients ages 18 - 59 years old, Ambulatory only. During today's visit, LPA used the infection control domain, rechecked the hot water temperature throughout the facility and reviewing client medications.

The following concerns were observed during today's visit;

At 8:35AM, LPA was not screened for COVID upon entry by Staff #1 (S1). At 8:40AM, S1 was observed working inside the facility without wearing a face covering/mask.

At 9:07AM, the hot water temperature was tested in the kitchen and measured at 122.2 degrees F. At 2:47PM, the hot water temperature was tested in bathroom #1 and measured at 121.2 degrees F. At 9:13AM, the hot water temperature was tested in bathroom #2 and measured at 120.4 degrees F.

At 10:32AM, LPA reviewed medications for Client #1 (C1) and observed that Zolpidem Tartrate 10MG Tablet (Bedtime) was not administered to C1 on 10/24/21 (was in the bubblepack) but initialed on the Medication Administration Record (MAR) as if it was administered to C1.

At 10:37AM, LPA observed Promethazine DM 6.25-15MG/5ML (PRN) was missing from the facility for C1.

The following deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6 (refer to 809D)

An exit interview was conducted and a copy of this report was provided to the Administrator along with the Appeals Rights.