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 Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with facility Administrator, Ana Alarcio, and Licensee Mona Dela Rosa, and explained the purpose for the visit.

During today's visit, LPA Maldonado conducted a tour of the physical plant with Licensee, observed the facility food supplies, reviewed (3) client medications, (3) client files, (3) staff files, and conducted interviews with Staff# 1-4 (S1-S4) and Client# 1 (C1). LPA was unable to interview the other (2) clients due to clients being out at day program. The facility is a single-story home, operating as an Adult Residential Facility, licensed to serve (4) adults, ages 18-59. It has an approved fire clearance to serve (4) non-ambulatory clients, and is approved to retain (1) hospice client, at any given time. The home consists of a kitchen, living room, dining room, (3) client bedrooms, (2) client bathrooms, attached garage with storage and laundry area, attached garage, and a shaded patio with sufficient space for outdoor activities.

All client bedrooms were inspected and had the required furniture, storage space, and lighting. Bathrooms were equipped with a toilet, wash basin, and showers. They had the required grab bars and non-skid mats. The water was tested and measured between 112*F-114*F, which is in compliance. The food supplies was observed and facility had the required 2-day perishables and 7-day non-perishables, as well as emergency food and water supplies available. Fire extinguishers were observed, with current inspections and were fully charged. The home was in good repair and walkways/ramps were observed to be free of debris and obstructions/hazards. Toxins and cleaning supplies, were observed stored under the sink and in the garage, locked and inaccessible to clients in care. All sharps/knives were observed stored in a kitchen cabinet next to the sink, locked and inaccessible to clients. Centrally stored medications were also observed locked in a kitchen cabinet, inaccessible. Laundry equipment was observed in good repair and operational during the visit. Sufficient linens, towels, and personal hygiene supplies were available. The facility has an approved mitigation plan on file and a current infection control plan submitted to the department. Sufficient PPE supplies were observed stored in the garage. Smoke/carbon monoxide detectors were observed in each room of the home and operational during the visit. Staff and client files were reviewed for required documentation, and observed to be complete. Client's medications were reviewed and observed to be documented properly and given as prescribed. Facility First Aid Manual and Kit were inspected and had the required items.

During today's visit, no deficiencies were observed or cited.

An exit interview conducted with Licensee and Administrator. A copy of the report was provided.