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 Administrator Jocelyn Manalo and explained the purpose of the visit. There are three (3) level 2 ambulatory 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 4 clients [ 2 non-ambulatory and 2 ambulatory]. It consists of 3 resident bedrooms, 1 staff room, 2 bathrooms, dining room, kitchen, living room, outdoor patio, enclosed porch/recreation room, and detached garage. Administrator certificate expires 11/29/2021.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction.

COVID-19 Infection Control Practices and signs were observed in the entrance, common areas, hallways, and bathrooms.There is a screening station at the entrance of the facility to screen visitors.

Room #3 is designated as a COVID-19 isolation room if needed. Personal Protective Equipment (PPEs) was observed.

Two (2) client centrally stored resident medication records were reviewed. Medications are documented properly and given as prescribed.

Staff were observed wearing mask. Clients do not wear masks due to disability.

The kitchen was inspected and a sufficient supply of perishable for 2 days & non-perishable foods for 7 days was observed. The kitchen stove back burners are not working.

A posted Emergency Disaster Plan was observed.

Facility has at least a 30-day supply of Personal Protective Equipment (PPEs).

Discarded appliances were observed in the front and backyard.

Wireless infrared smoke and carbon detectors were tested and are operational.

All staff have fingerprint clearances. Staff and resident files were not reviewed during today's visit.

***Facility has an Infection Control Plan that needs corrections. Licensee was instructed to submit the corrected Plan & the Monkey Pox Plan.

Per California Code of Regulations, Title 22, deficiencies are cited. See LIC 809D.

Exit interview was conducted with Administrator Jocelyn Manalo. A copy of the report/appeal rights were given.