Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced annual inspecti on focusing on the Infection Control Domain. LPA was allowed entry into this home by Ana Saavedra, Direct Support Professional/DSP and discussed the purpose of today's visit. LPA Pena spoke to Administrator, Denise Parra on the phone who stated that she will not be able to come to the facility. At 2:13pm, Program Supervisor Lizbeth Cortez arrived and assisted LPA with the inspection. The facility cares for Level 4-I Adult Residential age range 18 through 59, 4 ambulatory only. Facility is serviced by Harbor Regional Center. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed staff and resident files. This single-story home contains four (4) bedrooms, two (2) full bathrooms, a living room, kitchen, dining area, office area, backyard, and detached garage.

The facility had a universal entrance screening area including a thermometer, PPE supplies, screening logs, and sign-in sheet.

COVID-19 signage was placed in several areas of the facility.

Facility maintained a 30-day supply of PPE located in the shed outside and in the garage.

The laundry room is clean and has cleaning supplies inaccessible to clients.

The kitchen was inspected. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All the appliances are clean and are working properly.

Cleaning solutions and sharps were locked and inaccessible. However, LPA observed a Lysol cleaner under the bathroom sink , unlocked and accessible to clients.

Water temperature was measured in kitchen and bathrooms. Kitchen measured at 115.1 deg F, bathroom #1 measured at 115.3 deg F and bathroom #2 measured at 111.3 which are all within the required 105 - 120 degrees.

Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, night stand, light, chair and sufficient closet space.

Bathrooms have the required non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper.

Medications were locked, centrally stored, and given as prescribed. Clients' medications were reviewed to confirm medication is given as prescribed and is documented properly.

***Refer to LIC 809C for the continuation of this report.