Facility Evaluation Report

Applicant Home for Special Needs LLC--represented by administrator Lourdes Zamora--has applied for ARF licensure for 2 ambulatory adults, aged 18 to 59 years old. Fire clearance has been approved.

LPA Jeung toured facility and grounds of this 4 bedroom 2-story home. Common areas--living/dining room, family room, kitchen, laundry room, sun room and 2 car garage--re on the ground level, including office room and full bathroom. There are 3 bedrooms and 2 full bathrooms on upper level. The yard consists of 3 paved levels, a greenhouse/chicken coop, storage shed, and a hillside covered with vegetation. A large expanse of the backyard is level. Medications and toxins are secured; toolboxes secured with combination locks are used for medications and toxins are stored in locked cabinets in garage, laundry room, and upstairs bathroom. Food preparation and service items are present, as well as perishable fruits, vegetables and protein. Combination smoke/carbon monoxide detectors are present and tested. Supplies of bed and bath linens and hygiene products are observed. Hot water temperature tested at 105 degrees F in client bathroom on 2nd floor. Facility sketch is consistent with facility floor plan observed, and utility shut-off locations are accurately stated on LIC610D,

LPA discussed with Ms. Zamora that emergency signal system may be required if clients and staff sleep on separate floors, as per Section 85088 Fixtures, Furniture, Equipment and Supplies.

The following items are observed and must be addressed prior to licensure:

1. Visitor log is not set up yet. This should include date, time, name, contact number, affirmation of absence of COVID symptoms.

2. COVID signs must be posted,prominently, including handwashing reminder signs at bathroom sinks.

3. Thirty-day supply of personal protective equipment (PPE)--gloves, hand sanitizers, gowns, masks, N95s--must be maintained.

4. Stairs to 2nd level may pose a safety hazard due to the wood grain pattern. Colored tape is advised to clearly delineate the steps. (Section 80087 Buildings and Grounds)

5. Seven-day supply of non-perishable canned fruits and vegetables must be maintained (Section 85076 Food Service)