Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with DSP staff Elizabeth Hing and explained the purpose of the visit. Administrator Josefina Bernal arrived shortly after and was explained the purpose of the visit. There are five (5) level 4B developmentally disabled clients ages 18-59 in the home. The facility is a single story home located in a residential neighborhood that is licensed for 6 clients; of which two (2) can be non-ambulatory. It consists of 3 client bedrooms, office, living room, dining room, family room, kitchen, 2 bathrooms, backyard patio area, and attached garage. The last fire drill was conducted on 4/5/2021. Administrator certificate expires 2/25/2023.

The interior and exterior physical plant was inspected.

COVID-19 Infection Control signs were observed in the entrance, common areas, hallways, and bathrooms.

Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

Each client's room is designated as a COVID-19 solation room if needed.

Five (5) centrally stored resident medication records were reviewed.

Staff (S1) was not observed wearing mask when the door was answered.

Client's wear masks in the home as tolerated except during meal times.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Staff and resident files were not reviewed during today's visit.

Bedroom #1's window was missing a screen.

The left side iron gate door was observed to have a double sided door knob that requires a key from the interior of the facility. However it was not locked at the time of the visit. A technical violation was issued.

Exit interview was conducted with staff Josefina Bernal. A copy of the report was provided.