Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with House Manager Flavel Catahan. LPA also spoke briefly via phone with Administrator Lailani Velasco.

According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of six (6) residents in care, of whom two (2) were ambulatory and four (4) were non-ambulatory, but none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present.

LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA met with multiple residents and interviewed all staff who were present. LPA reviewed care records for all residents and personnel records for all active staff.

During the facility tour, LPA observed: In the facility’s kitchen were eight (8) sharp cooking and/or steak knives unlocked/unsecured. Of these, one (1) had a metal blade over ten inches long, and seven (7) had a metal blade over six inches long. Per facility records, 6 of 6 residents in care [Resident #1 (R1) through Resident #6 (R6)] were diagnosed with significant intellectual disabilities. [See LIC811 Confidential Names List for a description of person identifiers used in this report.] Regulation thus required these knives to be kept in “locked storage” when not in active use by staff. In 4 of 4 bathrooms used by residents, the showers did not have “slip resistant mats, strips, or flooring,” as required. [CONTINUED ON LIC809-C, 1 of 2]