Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Care Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA met with Direct Support Professional, Nizza Ybarra and explained the purpose for the visit. Administrator, Ana Alarcio, and Licensee, Mona Dela Rosa, arrived shortly after to assist with the visit.

The facility is licensed to serve (6) developmentally disabled adults, ages 18-59, of which (4) may be non-ambulatory.

The facility is a single-story home, located in a residential area. The home consists of (4) client bedrooms, (2) client bathrooms, a kitchen, living room, dining room, attached garage, a fenced pool, and shaded patio with seating area in the backyard.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and conducted a tour of the physical plant with assistance of DSP, Nizza Ybarra. The following was observed:

One central entry point for universal entry screening

Mitigation Plan and Infection Control Plan approved and in place

Sufficient PPE stored for 30-days and readily available for use, throughout the home and stored in the garage

Physical plant inside and outside is clean, sanitary and in good repair

All walkways and pathways observed to be free of obstruction/hazards