Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met Staff (Administrator in training) Alvin Capanzana 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, kitchen, dining area, Administrator office, staff room, laundry area, four clients bedrooms and two bathrooms and a attached garage. All clients rooms were toured. Bedroom#1 and #4 have two beds, two chairs, dressers, required bed linen and furniture and sufficient lighting and closet space. Bedroom#2 and #3 have one bed, one chair, one night stand, one dresser, required bed linen and 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 tested in both bathrooms were between 116.7 and 118.7 and they were within Title 22 regulation. The refrigerator in the kitchen and garage and the kitchen cabinet have sufficient two days perishable and seven days non perishable food supply. All the appliances in the kitchen are clean and working properly. The common area such as living room and dining area are clean and have the required furniture. The front and back yard are maintained well. The back yard has a shaded area with table and chairs for client to utilized. LPA also inspected the smoke detectors and carbon monoxide detectors and they are working well.

LPA reviewed all 6 clients emergency contact and they are all updated. LPA also reviewed 2 staff files and they are all finger print cleared and also their health screening forms are updated in their personnel files.

LPA reviewed 6 clients' medications and the medications are centrally stored in a medication cabinet and all clients' medication seemed updated and accurate.