Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit to the facility for the purpose of conducting the required annual inspection, using the Infection Control tool to evaluate the facility. LPA Maldonado met with caregiver Emma Banguguilan- Direct Care Professional (DSP) and explained the purpose for the visit. LPA conducted a tour of the physical plant with DSP, observed the food supplies, COVID-19 procedures, and reviewed client and staff files, and client's medications. The facility has an approved mitigation plan on file.

The facility is a one-story home located in a residential area. It is licensed to serve (6) developmentally disabled adults, ages 18-59, of which (2) may be ambulatory and (4) may be non-ambulatory. The home consists of a living room, kitchen, dining room, (3) resident bedrooms, (1) locked storage room, (2) client bathrooms, a shaded patio in the backyard with seating, and an attached garage. LPA observed all client bedrooms to have the required furniture, bedding, linens, sufficient lighting, closet space, and additional storage space. Bathrooms were observed to have a shower, toilet, and wash basin- all operational. The showers accommodate non-ambulatory residents and have the required grab-bars and non-skid mats. The water temperature was tested and measured between 107*F-114*F, which is in compliance. The food supplies was observed to be the required 2-day perishables and 7-day non-perishables. A fire extinguisher was observed in the kitchen to have a current inspection and was fully charged. The first aid kit was inspected and had the required items, as well as a current first aid manual. All sharps were observed to be locked and inaccessible in a cabinet in the kitchen next to the stove. Cleaning supplies were locked and inaccessible, stored in a cabinet underneath the kitchen sink and in the garage. Extra linens were observed in the storage room and were in good condition. The smoke/carbon monoxide detectors were tested, were interconnected and operational at the time of the visit. All equipment was operational and in good repair.