Facility Evaluation Report

On 03/16/2025 at 12:42 pm Licensing Program Analyst (LPA) Zina Brown arrived at the facility. At 12:48pm, LPA entered the facility to conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection.LPA met with Brandon Penalosa to discussed the purpose of the visit. The facility is licensed to operate for four (4) ambulatory disabled adults. Currently, the home has (4) clients. The clients are Harbor Regional Center clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices. On 03/11/2025 at 5:32 pm, the facility paid the annual fees online. The facility has liability insurance wit Pennsylvania Manufacture's Association Insurance Company (Policy #3824011419126) effective dates: 10/13/2024 - 10/13/2025.

The facility is a two story home located in a residential neighborhood. The property consists of the following: 4 client bedrooms, 2 storage rooms upstairs, 2 common bathrooms, a pnatry closet, an office area, a den, a living room, a kitchen, dining room, attached garage which houses the washer and dryer with a deep freezer and an outdoor shaded area.

Between the hours 1:45pm - 3:04pm of LPA conducted a records review of (4) client records, (4) staff records, (4) clients Personal & Incidental Records, (4) Client Medication Administration Records and reviewed the facility disaster plan (last conducted February 2025).The facility disaster plan was current and in compliance with Title 22 at the time of visit.

Between the hours of 1:04pm - 1:20pm, LPA and Brandon Penalosa toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed , plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105-120F ( Bathroom #1: 107.6 F & Bathroom #2: 109.7F & Kitchen: 108.8F).