Senior Care Records.A MITRYXA product
For operatorsSign in

Facility Evaluation Report

Midomar Home V, West Covina09/19/2023Licence 197803160

Capacity6
Census5
Date signed09/19/2023 03:46:02 PM
The inspector’s account

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 09/19/2023 at 9:00 am. LPA Ramirez was met by staff #1 (S1) explained the purpose of the visit. The facility is licensed serve six (6) developmentally disabled clients 18-59 years old, of which four (4) may be non-ambulatory. The facility is a level 4C home. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020).

LPA OBSERVATIONS: Tour began at 9:11 am and was led by S1. The facility is a single-story building located in a residential area with four (4) client bedrooms, two (2) staff bedrooms, two (2) bathrooms, kitchen, dining room, living room, attached garage, front yard, backyard.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to five (5) out of five (5) clients in care. LPA Ramirez observed a fully charger fire extinguisher nearby.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed with plenty of lighting. LPA Ramirez observed several boxes with various items, stacked in corners of the living room area. Per S1, the facility was recently painted, and the facility is moving boxes around in order to paint and do light cosmetic work on the facility. LPA Ramirez will issue Technical Advisory. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and handwashing etiquette in this area.

Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 4: LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction