Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Annual Required Visit on 09/05/2024.. LPA were met by Staff #1 (S1) and explained the purpose of the visit. S1 assisted in tour of facility. Administrator Gerardo Zamora arrived shortly after to the facility and was explained the purpose of the visit. The facility has a fire clearance approved for two (2) ambulatory and two (2) non-ambulatory clients. All clients receive services from East Los Angeles Regional Center. LPA observed Personnel Report and Resident Roster. The facility currently has 4 clients.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices and Personal Protective Equipment (PPEs) were observed.

· LPA observed that the facility has an infection control plan in place.

· LPA conducted a tour of the facility with S1 and observed the following:

The facility is a single-story building in a residential area, with a kitchen, dining room, living room, two (2)

client shared bedrooms, one (1) staff bedroom, and the backyard with shaded area and a garage.

· All passageways, walkways, driveway, steps and patio are free from obstructions. The front, back and

side areas of the house are free of hazards.

· Hallway linen closet: Contained plenty of linens, towels. · PPEs and cleaning supplies are stored in a locked cabinet in the garage.