Facility Evaluation Report

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Administrator Santiago Barcena and explained the reason for the visit. The facility is licensed to serve 4 ambulatory clients. The facility is in a residential area. A tour of the single-story facility included: 4 client bedrooms, 1 staff bedroom, 3 bathrooms, 2 living room, staff office room, kitchen, dining area, laundry area, detached garage, and front yard, and backyard.

LPA Mora conducted the tour with Santiago Barcena and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen and in the refrigerator located in the garage. Sharps were observed locked in a kitchen cabinet. Chemical and cleaning solutions are kept locked in a cabinet above the washing machine and dryer. The First Aid kit is kept locked in hallway cabinet and it is fully stocked with all required items including a current manual. There is a closet in the hallway with clean towels and extra linen. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in a cabinet located in the staff office room. All bedrooms have all required furniture, lighting, and bedding. The 3 bathrooms were observed with shower mats. The water temperature was tested and measured between 113.5 and 115.4 degrees F, which is within the required 105-120 degrees F. Fire extinguishers were observed in the kitchen and second living room, and are fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. A carbon monoxide was observed in the dining area and was operable during the visit. The front yard and backyard are clean. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.

LPA reviewed medication for three of the four clients. One client does not have any medications prescribed. Medications are documented properly and given as prescribed. Client and staff files were not reviewed in today’s visit. LPA observed administrator certificate for Santiago Barcena - 6061023735 with an expiration date of 12/05/2023. (CONTINUED TO LIC 809C)