Facility Evaluation Report

Licensing Program Analyst (LPA) Mayra Cota and Jewel Baptiste conducted an unannounced annual visit at the facility using the CARE inspection tool.

The facility is licensed to served three (3) ambulatory only and one (1) non-ambulatory, developmentally disabled adults ages 18-59. Facility is a single home located in a residential neighborhood, and consist of a receiving room, kitchen and dining area, one (1) live-in staff bedroom, four (4) client bedrooms, two (2) bathrooms, one (1) laundry room, living room with a non-working fireplace, an attached garage, a front yard, and a back yard.

LPAs conducted a tour of the facility with Eleuterio Nebria and observed the following: (4) client bedrooms, contained required furniture, lamps, dresser, chair, and closet space. Bedroom #1 mattress had a hole. The two bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 104.4*F-106.7*F respectively. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (1) fire extinguisher located in the hallway, charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The cleaning agents and toxins was locked and secured in a kitchen cabinet. Sharps and medications were locked in Staff bedroom. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.)