Facility Evaluation Report

On 3/2/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit. LPA met with the Administrator, Evelin Lopez and explained the purpose of today’s visit. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. The facility is licensed approved for (3) Non-ambulatory developmentally disabled clients (age 18-59). Approved for delayed egress. The census is currently 3.

185 th , is a one-story structure located in a residential neighborhood. The facility consists of (3) client bedrooms, (2) bathrooms, living room, kitchen, dining area and the attached garage is being used as an office and a storage room. Facility maintains all required posting throughout the facility.

LPA conducted a records review of (3) client records, (5) staff records, and (1) client medications. All client & staff records were complete. LPA Shirley and Evelin walked throughout the facility and all common areas such as the living room and dining room were all observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked . Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature delivered at 105.6 F.

LPA observed that there is ample seating and space for all clients. All walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. Smoke/ Carbon Monoxide detectors were operable. The last fire/emergency drill was conducted on 2/24/26. There is (3) charged fire extinguishers last serviced 1/2026. Exterior areas are clean and clear of obstructions and hazards and there are no bodies of water present.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Evelin Lopez.