Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Socorro Calingasan and explained the purpose of the visit. There are 3 level 4I ambulatory developmentally disabled clients ages 18-59 in the home. The facility is a single story home licensed for 2 ambulatory and 2 non-ambulatory clients located in a residential neighborhood. It consists of 4 client bedrooms, 1 office room, 2 bathrooms, dining area, kitchen, living room, lounge room, backyard patio area, and attached garage. The last fire drill was conducted on 9/5/2021. Administrator certificate expires 4/1/2023.

The interior and exterior physical plant was inspected.

COVID-19 Infection Control Practices and signs were observed in the entrance, common areas, hallways, bathrooms and resident rooms.

Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Furniture was observed to be at least 6 feet apart.

Each client's room is designated as a COVID-19 solation room if needed.

Three (3) centrally stored resident medication records were reviewed.

Due to client's disability and behaviors only some of the clients in care wear masks.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed. .

Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Administrator Socorro Calingasan. A copy of the report was provided.