Facility Evaluation Report

At approximately 9:00AM, Licensing Program Analysts (LPAs) Felias and Deniz arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Huai Hen, Administrator, Agnes Dizon and Designated Representative, Alan Yang, arrived to facility at approximately 9:30AM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance for 2 ambulatory and 2 non-ambulatory clients with a total capacity for 4 Clients. Upon arrival, LPAs was informed that there were 4 clients in care, with all clients out of the community attending Day Program. LPAs were also informed that there was 1 staff member on-site.

LPAs reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPAs conducted a walk-though of the facility with Administrator. LPAs observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a two story building with 4 Client bedrooms, 3 staff rooms, 3 bathrooms, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPAs observed a knife that was in an unlocked drawer (technical advisory issued, LIC9102, regulation 80087(g)). LPAs observed Administrator immediately place knife in an inaccessible cabinet. LPAs also observed 3 separate holes throughout the facility. 1 hole was located in the dining room and the other two holes were located in 2 client rooms. LPAs observed that all 3 holes were approximately 5 inches long. Per conversation with Administrator, the two clients have property destruction behaviors (technical advisory issued, LIC9102, regulation 80087(a)). During visit, facility staff fixed and patched all 3 holes.

LPAs reviewed staff and client files, client medication, and P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. P&I monies were documented, secure and not commingled. Medication was observed to be centrally stored and secure.