Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA was met by House Manager Darlene Carcoba and explained the reason for the visit. LPA was later met by Administrator Lavonia Williams. There are four (4) level 4e developmentally disabled clients in the home. The facility is licensed for clients 18-59 years old. There are 2 residents over the age of 60 years old. The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen/laundry area, dining area, 4 Client bedrooms, 3 bathrooms, staff room and a detached garbage/office/storage.

· All outdoor and indoor passageways are free of obstruction.

· COVID-19 Infection Control signs were observed in the entrance and bathrooms. Screening protocols are in place. Clients in care do not wear a mask because it is not tolerated due to cognitive impairment.

· Four (4) centrally stored resident medication records were reviewed. Facility maintains a 30-day supply of medications. LPA observed medications to be unlocked and accessible to clients during visit. During medication review LPA observed C1, C2, C3, C4 all had medication that was administered on 01-13-23 at PM but not initialed by staff. LPA observed C1, C2, C3, C4 all had medication administered on 01-14-23 at AM but was not initialed by staff.

· Kitchen water measured at 109.5 degrees F which in with the required 105 – 120 degrees F. Kitchen cabinet drawer located near sink is missing. Knives and sharps were observed in an unlocked cabinet and accessible to clients during visit. Nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days were observed.