Facility Evaluation Report, 08/18/2022 — South Star #2, Costa Mesa CA

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to South Star #2. LPA Velazquez was allowed entry into the facility and met with House Administrator (HA) Oscar Mejia. Administrator Lommel Tumbokon arrived later to assist with the visit. The purpose of the visit was to conduct a Post Licensing visit . The facility is a Community Crisis Home - Adult Residential Facility. The facility is licensed for 5 ambulatory clients of which 3 may be non-ambulatory. The facility has also been approved for delayed egress. The last emergency disaster drill was conducted on July 16, 2022.

At 2: 56 PM LPA Velazquez conducted a tour of the physical plant along with HA Mejia The 1 story home consists of 5 client bedrooms with 3 bathrooms. There is sensory room, living room, sitting area, activity room, living room, medication room, dining area and kitchen. The 1 client in the facility appeared well-groomed and well cared-for. The client bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each client comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, showers were free of mold/mildew and a non-skid surface or mat was in place. Client bath towels and personal hygiene supplies were adequately stocked. LPA Velazquez tested the hot water temperature in the client bathrooms and the temperature measured at 109.5 degrees Fahrenheit in the first bathroom, at 112.6 degrees Fahrenheit in the second bathroom, and at 105.5 degrees Fahrenheit in the third bathroom which HA Mejia verified.

LPA Velazquez inspected the kitchen along with HA Mejia. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. The fire extinguishers were fully charged. The smoke and carbon monoxide detectors were interconnected, tested and found to be operational. Medications, toxins and sharps were locked and inaccessible to clients. The home has a fire sprinkler system that has been approved by the Fire Marshal.