Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with Direct Support Professional (DSP) Gloria Guiyab and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed client and staff files.

The facility is a single story house and located in a residential neighborhood area. The facility includes living room, staff office dining area, kitchen, three clients bedrooms, one staff room, two bathrooms and attached garage. All 3 clients bedrooms were toured. Bedroom#1 and #2 has one bed, one night stand, required bed linen, furniture and sufficient lighting and closet space. Bedroom#3 has two beds, two night stands, required bed linen, furniture and sufficient lighting and closet space. All 2 bathrooms were toured and they are clean, sanitary and in a good working condition. The hot water temperature in two bathrooms were tested between 114.4 and 114.5 degrees F which is within the Title 22 regulation. The refrigerator and the kitchen cabinet has sufficient 2 days perishable and 7 days non-perishable food supply. All the sharp knives and utensils are locked in the kitchen drawer. All the toxic and cleaning supplies are locked under the kitchen sink which is inaccessible to clients. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The front and back yard are maintained well and the back yard has a shaded area with tables and chairs for clients to utilize. LPA also inspected the smoked detectors and carbon monoxide detectors and they are all interconnected and working properly.

LPA reviewed 4 clients files to confirm emergency contact LPA also reviewed staff files to confirm health screenings and fingerprint clearances and they are all fingerprint cleared and updated in the file. LPA reviewed all 4 clients medications and they are all accurate and updated. They are all centrally stored and locked in the kitchen cabinet.