Facility Evaluation Report

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by DSP Pepipo Esguerra the purpose of today’s visit was explained.

There are currently (4) Regional Center consumers in placement . All (4) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, family room/office, living room, kitchen, dining room, shaded area, indoor and outdoor activity area, laundry room and attached garage.

LPA and DSP toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 – 2 are occupied by clients and contain the mandated furniture bedroom 3 is vacant. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current along with medications. The water temperature is within Title 22 limits. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, 1 fire extinguishers are fully charged/or hazards. The facility is in good repair with the Exceptions: Grease covering the kitchen walls. Kitchen Floor has torn areas. Kitchen cabinet has broken drawers. Debris is in backyard that could propose a risk to clients in care. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, sanitizer/soap in the staff bathroom and additional sanitation supplies in a locked cabinet located in the garage. LPA observed staff wearing and clients not wearing masks, clients can isolate in their room if necessary required postings throughout the facility. The administrator advised LPA that sanitizer is administered to client with the supervision of staff, but sanitizers are not kept in their rooms for safety reasons. The facility has an approved Mitigation plan staff has not been N95 fit tested. Visitors are logged and checked. The client’s temperatures are checked and logged 2x a day.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe Deficiencies , therefore Citations were issued at this time. See 809-D pages

An exit interview conducted with , HAI Nguyen Administrator and copy of report provided.