Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with DSP Irayda Perez and explained the reason for the visit. Shortly after, the facility representative Roger Escorcia arrived and assisted with 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 clients and staff files.

The facility is a single story house. The facility is included kitchen, dining area, laundry room, a den/staff office/client's activity area, living room, three clients bedrooms and two bathrooms and a detached garage. All 3 clients bedrooms were toured, Bedroom#1 and #3 has one bed, one chair, one night stand, one drawer, required bed linen and furniture and sufficient lighting and closet space. Bedroom#2 has two beds, two chairs, two night stands, two drawers, 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 in two bathrooms were tested between 105.4 and 106.5 degrees F. which is within Title 22 regulation. The kitchen cabinet and the refrigerator has the 2 days perishable and 7 days non perishable food supply. The sharp knives and utensils are locked at the kitchen cabinet. All the kitchen appliance 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 and the back yard has a shaded area with tables and chairs for client utilized. LPA inspected the smoke detectors and carbon monoxide detectors and they are all working properly.

LPA reviewed 3 client files to confirm emergency contact is updated. LPA also reviewed 3 staff files and they are all finger print cleared and they also have updated health screening form on their staff personnel file. LPA also inspected all 3 clients' medication and all seemed updated and accurate.