Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds, located at 2470 Olympic Drive, SSF. This one level home consists of 4 client bedrooms and 2 shared bathrooms, kitchen, dining and living rooms. Grab bars are not yet installed for 2 toilets and 2 showers, as required for non-ambulatory licensure. There is a wood deck in the rear and sides of building. Facility serves Level 4 Regional Center clients with medical and behavioral needs. No accessible bodies of water or fire safety hazards are observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate and infection control signs are posted prominently. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There is one resident present, and 1 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed; first-aid training for staff is checked. Paula Jane Garcia is a certified ARF administrator (x 1/2023) that oversees facility operations with Editha Guevarra.

The following licensing forms/information are requested to be submitted to CCLD by 1/5/21:

- LIC 308 Designation of Administrative Responsibility

- LIC 200 Application (to provide correct street address and phone numbers)

Updated Emergency Disaster Plan (LIC610) is given to LPA today.

Annual fee is overdue and amount of $681 is due and payable.

Deficiency of the CA Code of Regulations, Title 22, Division 6, is cited on a following page. See also Technical Advisory note.