Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit with focus on the infection control domain, food review and medication review. LPA Flores met with Surya Correa direct support staff and explained the reason for the visit. Damion Lee - Residential Director arrived an hour and a half later.

Facility is a single story home and it is licensed to served 6 ambulatory clients between the ages of 18 to 59 years old. Facility has no fences or large bodies of water. Facility has 3 client rooms, 1 staff room, 2 client bathrooms, a living room, a dinning room, a kitchen, a basement inaccessible to clients, a shaded sitting in the front porch and a back yard. LPA Flores observed the following: All client bedrooms have the required bedding and furniture. Bedroom #2 has one working dim lamp and requires additional lighting. LPA tested water temperature in bathroom #1(B1) which tested at 108.8 degrees F and bathroom #2(B2) which tested at 109.0 degrees F, which is within the required temperature of 105 to 120 degrees F. LPA observed facility's kitchen refrigerator and did not observed sufficient perishable food for at least 2 days, observed 7 days of perishable food. Cleaning and disinfectants were locked under the kitchen's sink, and knives were stored in a drawer to the right of the kitchen's sink which was not locked at the time of the visit. Door handle was fell off the exit door to the back yard as client opened the door. Smoke detectors/carbon monoxide detectors were tested and working properly. Fire extinguishers were observed by the kitchen and last checked on 8/21/21. LPA checked Client #1(C1), #2(C2), #3(C3) medication and files. Administrator's certificate # 6033708735 expiration date: 9/4/21 renewal in process. Damion Lee's certification #6030561735 expiration date: 4/2/22.

Facility is following COVID 19 recommendations by posting signs throughout the facility, screening upon entering the facility, staff were observed wearing a face mask, PPE was observed at the facility for at least 30 days, emergency food supplies were observed.

Deficiencies were cited on 809D and technical advisory notes per Title 22 regulations.

Exit interview was conducted with Damion Lee - Residential Coordinator and a copy of this report, 809D, and appeal rights was provided.