Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control domain, food and medication review. LPA Flores met with Cesar Gomez administrator and explained the reason for the visit.

The facility is licensed as an Adult Residential Facility to serve 4 adults with Special Health Care Needs (ARFPSHN) and is vendor through Eastern Los Angeles Regional Center with a staff/client ratio of 1:1. The facility is a single story home, with 4 bedrooms, 2 bathrooms, a dining room, living room, family room, kitchen, laundry room, garage, and an outside shaded backyard located in residential neighborhood. No large bodies of water were observed.

LPA Flores tour the facility with Cesar Gomez administrator and Sally Wu nurse and observed the following:

Living room has a covered fired placed, dinning room, and family room have sufficient lighting and space. Kitchen area was observed to have food supplies of 2 days of perishables and 7 days of non-perishables. Knives were locked in a drawer to the right of kitchen sink. Overflow medication and medical supplies locked in cabinets in the kitchen. All bedrooms have sufficient lighting, furniture, and required bedding. Fire extinguisher was observed outside Bedroom #1 last checked on 6/21. Bathroom #1 has grab bars, mats, a shower bed, water temperature was tested at 115.7 degrees F which is within the required 105 - 120 degrees F. Bathroom #2 is used by staff only. Smoke/Carbon Monoxide detectors are interlace, were tested and are in working condition. Medication cart was observed locked, located in the dinning room. LPA reviewed medication for client #1(C1) and #2(C2) and files for C1, C2 and staff #1 and #2. Administrator certificate was observed for Cesar Gomez #6041407735 expiration date: 11/24/22.

Facility is following COVID 19 recommendations; screening logs were observed for visitors, staff, and clients. PPE supplies were observed for over 30 days. Staff have been fit tested for N95 and were observed wearing face mask at the facility. Signs were posted throughout and near sinks, hand soap and paper towels available.

No deficiencies were given during this visit.

Exit interview was conducted with Cesar Gomez administrator and a copy of this report was provided.