Facility Evaluation Report

On 01/31/22 at 9:50 a.m., Licensing Program Analyst (LPA) Toan Luong conducted an unannounced annual visit to the facility. LPA with Staff (S1) Jonelyn San Antonio and explained the purpose of the visit. The facility is an Adult Residential Facility with funding from Tri-Counties Regional Center.

At 9:50 a.m., LPA arrived at the facility and saw one sign on a door of the house stating no visitors were allowed. The house had multiple front entrances, and neither of the doors had any other signs. LPA advise S1 to update signs for current visitation policy and to redirect visitors to a central entrance. Upon entry, LPA was screened. LPA recommended staff have hand sanitizer near the entrance for visitors to use.

At 10:32 a.m., LPA entered the kitchen storage room adjacent to the kitchen. LPA and S1 observed a box containing two one gallon Chorlox bottles underneath a table. The box was besides cooking oil. On the table, LPA and S1 observed one Lysol canister besides 2 bottles of maple syrup. A box with two one gallon Dawn dish soap were also observed underneath the table. Cleaning products were unused and unopen. Staff explained to LPA that products were purchased from Costco and stored there temporarily. Staff removed the cleaning products. LPA and S1 observed one molding orange and lemon on the same table. The lemon was in a basket with other lemons. Staff discarded the molding fruits. The facility has a backyard with fruit trees that family members pick from but did not dispose or stored it properly.

At 11:00 a.m., LPA went over the Infection Control module and advised S1 that the facility will need to have staff fit tested with N95 when working with Covid-19 positive clients.

LPA issued citation on LIC 809D, conducted exit interview, provided appeal rights, and emailed report to the administrator.