Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met Virginia Wilson caregiver with and explained the reason for the visit.

The facility is licensed to serve six (6) developmental disable ambulatory only clients, from age 18-59. The facility is a single home located in a residential area and consist of a living room, a kitchen/dining room, 3 client bedrooms, 1 client bathroom, a staff room, a staff bathroom, a laundry area, a garage, and a backyard.

LPA reviewed the following CARE inspection tool domains during this visit:

Infection Control: An infection control plan was submitted to the department. Hand sanitizer and proper sanitation was observed during the visit. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed.

Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license.

Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Virginia Wilson and observed the following: Facility was observed in good repair indoors and outdoors. Common areas provide sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a cabinet. Medications were observed locked in staff's room. Cleaning supplies were observed inaccessible to clients.. Laundry area was observed in good repair. LPA observed all client rooms, each in good repair, with all bedding supplies, and sufficient lighting. Client bathroom was observed in good repair, and water temperature was tested at 98.6 degrees F., which is not within the required 105-120 degrees F. (CONTINUED ON LIC 809C)