Facility Evaluation Report, 03/30/2023 — Midomar Home IV, West Covina CA

Licensing Program Analysts (LPAs) Christine Wong and Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with House Manager Irene Leonor allowed the entry of the facility. Shortly after, LPA met with the Assistant Administrator Bettina Santiago and assisted with the visit. The purpose for the visit was explained. The facility is licensed for 2 non-ambulatory only - licensed can only serve developmentally disabled adults age 18 through 59.

LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and inspected these domain:

Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting at least once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan.

Physical Plant and Environmental: The facility is a single story house and located in a residential neighborhood area. The house include: four clients bedrooms, two clients bathrooms, two live in staff rooms, kitchen, dining area, sitting room, family room/living room, staff office and an attached garage. All clients bedrooms have the required furniture and beddings. All bathrooms are clean, sanitary and in a good working condition. All the sharp knives and utensils and chemicals are locked and inaccessible to clients. All the clients personal hygiene are stored in the hallway cabinet. LPA inspected the carbon monoxide detectors and smoke detectors and they are all working properly. LPA tested the hot water in the facility and they were tested between 107 and 107.5 degrees F which is is within the Title 22 regulation.

Operational Requirements: The facility currently has 4 clients and they are all ambulatory and its within maintained the fire clearance approved by the city. The facility also has a shaded area with table and chairs in the patio for clients to utilize.

Staffing: The facility has sufficient staffing in the facility and the night supervision staff has the required training for planned emergency procedure training.