The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is an Adult Day Program (ADP), with an approved fire clearance capacity of One Hundred and Five (105) clients. The facility is approved for Ten (10) Non-Ambulatory clients. The hours of operation for this ADP are Monday-Friday from 7:00am-4:30pm. Clients are supervised in the ADP Monday-Friday from 8:00am-4:00pm.

FOOD SERVICE: As this is an Adult Day Program (ADP), clients bring their lunch and snacks. The facility has emergency food supplies and snacks available for clients.

COMMON AREAS/COMMON ACTIVITY SPACE: The facility is a single-story structure with a conference room, Staff offices, relaxing/multipurpose room, creative arts/arts and crafts room(s), life skills room, three (3) restrooms, training room, and staff break area. At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were operational at the time of the visit. The facility has multiple fire extinguishers that were fully charged and serviced annually. The facility contains extra storage areas for additional perishable food, and client activity supplies. The LPA observed required postings throughout the common spaces including Client Personal Rights and Contact information for Ombudsman as well as Licensing. All equipment used in all common areas was observed to be clean and in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for client use.

Continued on 809-C

RESTROOMS: There are Three (3) communal client restrooms in the facility. Facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restroom areas inspected had non-skid surfaces to prevent any danger to clients in care. There are no showers in the facility as this is an Adult Day Program (ADP). The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms within the appropriate temperature regulations. The restroom had sufficient required postings.

RECORDS: The facility keeps confidential storage of both client and Staff member records on-site at the facility. Staff member records were reviewed for, but not limited to Health Screening Report/Tuberculosis (TB) Clearance for facility personnel, Personnel Record (employment application), verification of age over 18 years old, education, and experience, Adult Day Program (ADP) Administrator qualifications, verification of first aid training, Criminal Record Statement, Criminal Record Clearance/Exemption, Verification of Staff training, Employee Rights, and Abuse Reporting Requirements. All staff members’ personnel records reviewed by LPA had the appropriate documentation. Staff responsible for the day to day operation of the program meet the qualifications for Adult Day Program Administration. Client records were reviewed for, but not limited to Pre-Admission/Placement appraisals, Client Appraisals, Appraisal Needs and Services Plan (ANS), Tri-Counties Regional Center (TCRC) Individual Program Plan (IPP), Physicians’ Reports, Identification and Emergency Information, Current Admission Agreement with signatures, Personal Rights for Clients, Record of Clients safeguarded cash resources, Record of Client personal property/valuables, Responsible Person or Conservator of Client, Self-management of medications if applicable, Medication Orders, and Medication Logs. Several client records reviewed by LPA had missing or incomplete information including the absence of an admission agreement in one (1) client record, the absence of signed consent forms in several, and the lack of a documented Needs and Services Plan in one (1) client record.

MEDICATIONS: The facility maintains a locked centralized storage area for client medications. Centrally Stored Medications are stored in a locked cabinet in a facility office. There is a signed and dated order from physician for prescriptions and PRN medications. LPA observed the medication assessment record (MAR) and that the medication is given per physician's orders. The medications remain locked at all times, inaccessible/locked to clients. Continued on 809-C

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps posted copies of facility documentation such as the Adult Day Program (ADP) License Certificate, Personnel Report/List of current staff members employed at the facility, Business License Certificate, Facility insurance information, Plan of Operation, Emergency Disaster Plan for the Facility, Infection Control Plan/Mitigation Plan, Valid Administrator Certificate, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, clients, visitors, and accessible to LPA upon request during the inspection process. All vehicles used to transport residents are maintained in safe operating condition.

INTERVIEWS: During the annual facility site inspection, LPA interviewed four (4) staff and four (4) clients. No immediate concerns were voiced to the LPA at this time.

LPA noted that several technical violations were delivered, but no citations were issued during this annual inspection at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.