Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual visit at the facility with focus on the CARE TOOL domain, medication and food review. LPA Calderon met with House Lead Manager Derry Samdijam and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory clients ages 18-59. The facility is operating within the scope of its license, 1 client over 59 years of age.

A tour of the single-story facility included the 4 client bedrooms, 2 client bathroom, kitchen, dining area, living room, laundry area, front yard and backyard and attached garage.

LPA conducted the tour with House Lead 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. Sharps are kept locked and inaccessible to clients in care. Cleaning chemicals are kept locked and kept in room in kitchen area. The First Aid kit is kept locked in the medication cabinet and it is fully stocked with all required items including a current manual. Medications are kept locked in a dining area cabinet medication was checked for 3 clients and no deficiencies noted. Client files are kept locked in medication cabinet and staff files are on an online portal, all documentation's are present and staff are cleared. Two clients have a restricted health condition plan in place.Clean towels and extra clean linen were observed in a hallway cabinet. Dining and living room have sufficient lighting and sitting area. All bedrooms have all required furniture, lighting, and bedding, there is a resident with half bed rails and a physician order in place. The bathrooms were observed with shower mats and grab bars for non-ambulatory clients. The water temperature was tested in the both bathrooms and measured within the required 105-120 degrees F. Fire extinguisher were observed in the kitchen, and are fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. The carbon monoxide was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.