Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Anna Marie and Asfunso Elam 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 Lopez conducted a tour of the facility with Ana Marie and Alfunso Elam and observed the following:

Facility is in good repair inside, outside needs touch up paint in some parts as paint chipping. Living room has a cover fireplace. Dining room has a medication cabinet under lock. All clients PRN medications are missing PRN authorization letters. Kitchen was observed clean, cleaning supplies, and sharps are kept in a closet next to the laundry area with a lock. 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 114.4-116.4 degrees F. which is 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. Client cash resource log needs to be updated.

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 needs updating. Last fire drill was conducted on 12/07/2023. Per administrator an infection control plan was submitted to the department on 7/10/23. LPA interview 2 staff and 1 client.

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