Facility Evaluation Report

On 11/01/23 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, visit to the above mentioned facility to finish client and staff record reviews. LPA was met by LaCresha Grant, DSP2 (S2) and later by the Administrator, Baltazar Cornejo (S1). LPA was allowed entry to the facility and the purpose of today’s visit was explained. The facility is licensed to operate for four (4) ambulatory developmentally disabled adults aged 18 through 59 years. All four (4) clients are Harbor Regional Center consumers.

The visit consisted of record reviews of all four (4) clients and three (3) staff files. All client files were reviewed and it has been observed that all files contain a face sheet with proper ID/contact information, but only one (1) out of four (4) resident files contain Identification and Emergency Information (LIC601), all four (4) clients' folders contain current Physician Report (LIC602), one (1) out of (4) clients' files have a complete Admissions Agreement (SEE LIC604), two (2) out of four (4) clients' files contained personal rights information (LIC613), all four (4) clients' folders contain Individual Services Plan (ISP) which may suffice for the Appraisal/Needs Services Plan (LIC625). An advisory note of Technical Violation was provided, see LIC9102.

Three (3) staff files were reviewed and all staff files contain the required documentation.

An exit interview was conducted with Administrator, Baltazar Cornejo (S1) and a copy of this report and the advisory note was provided.