Facility Evaluation Report, 10/12/2022 — La Vaca Homes, Lake Forest CA

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 1 staff was on duty, who contacted facility administrator (AD) John Dofredo about visit. AD Dofredo was unable to be present during time of visit, however, provided consent for staff on duty (S1) to conduct tour, receive and sign report. As of 10/12/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted at the entrance of the facility. The PUB475 "See Something, Say Something" poster was observed to be located in the kitchen LPA De Perio observed the Administrator's Certificate for Wilfred John Doferdo, which expires on 8/24/23.

LPA De Perio toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 4 clients, ages 18-59 of which 4 may be may be ambulatory. Currently, there are a total of 4 clients in care, of which 2 clients were present during today's visit and 2 were attending Day Program. There are a total of 4 private client bedrooms. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards.

Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are two restrooms in the facility (one shared and one in a bedroom), of which both restrooms were observed to be in good repair, and toilets were operational. Water temperature in restrooms were measured to be at 107.9 degrees Fahrenheit and hand washing signs were also posted.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to clients in care and located in the kitchen. Fire extinguisher was charged, mounted and located in the living room.