Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Asfunso Elam Assistant administrator and explained the reason for the visit.

The facility is licensed for four (4) Developmentally Disabled Adults, ages 18 to 59. Two (2) of the four (4) may be non-ambulatory. The facility is a one story house with 2 shared client bedrooms, 1 client bathroom, living room, dining room, kitchen, family room, a staff room, a staff bathroom, and an attached garage.

LPA Flores conducted a tour of the facility with Asfunso Elam and observed the following:

Facility is in good repair inside and outside. Living room has a cover fireplace. Dining room has a medication cabinet under lock. Kitchen was observed clean, cleaning supplies, and sharps are kept in a closet next to the laundry area with a lock during the visit. Refrigerator was observed and temperature was observed at 55 degrees F. which is not within the recommended to at least 45 degrees F. Sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Family room has a cabinet with activity materials. Client bedrooms (2) have sufficient lighting, required furniture and bedding. Bathroom was observed in working condition, water temperature was tested at 102.9 degrees F. which is not within the required 105-120 degrees F. Freezer was observed in the garage at 0 degrees F. which is within the recommended temperature. Smoke/Carbon monoxide detectors were tested and in working condition. Fire extinguisher was observed and last checked on 7/15/23.

LPA reviewed medication and files for 4 clients, and 5 staff files. Administrator certificate #6013989735 exp date: 6/15/23 was submitted for renewal and it is pending. Emergency Disaster Plan (10/03) was observed and additional plan which did not meet the required fields. Last fire drill was conducted on 6/20/23. Per administrator an infection control plan was submitted to the department on 7/10/23. Interview 2 staff and 1 client.

Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Asfunso Elam and a copy of this report, LIC 809D, and appeal rights were provided.