Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced visit at the facility to conduct the required annual inspection. LPA Ramirez was greeted by Administrator Santos Dominguez and explained the purpose for the visit. The facility is an Adult Day Program for Intellectually Disabled Adults, licensed to serve 20 ambulatory and 10 non-ambulatory consumers, ages 18 and over.

This program operates Monday through Friday from 8:00 AM to 2:00 PM and provides services for the developmentally disabled clients. This program has the following: (6) Vocational rooms for skill learning assignments, (1) kitchen, (2) restrooms and (5) staff offices. Storage lockers for both staff and clients observed.

Physical Plant: Outdoor and indoor passageways are free of obstruction. Bathrooms were clean and operational, water temperature in compliance. Restroom located in Administration section which is accessible to staff and clients, was observed to contain 2 bottles of disinfectant spray on sink counter. Administrator Dominguez witnessed disinfectant sprays and immediately removed them. LPA Ramirez will issue Type A deficeny based on this observation. Smoke/carbon monoxide detectors were tested and operational. Fire extinguisher observed. Required postings observed. Central Air and Heating with temperature comfortable. Emergency supplies observed. Sharps were observed to be locked and inaccessible to clients. MEDICATION: Not all clients at this program receive medications while in day program. No centrally stored medications were observed. PERSONNEL RECORDS: Four (4) Staff records were reviewed. LPA Ramirez observed First Aid/CPR Certificate, Fingerprint Clearance/ Exemptions, Personnel Record/Job Application, Health Screening, Employee Rights, TB Test, and annual training. CLIENT RECORDS: Client records are maintained at the facility. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, and Personal Rights Form were observed in records. Staff on site meet ratio set by regional center. ACTIVITIES : LPA observed activities for client use as well as sufficient space and accommodations for clients to do activities. Three (3) vehicle registrations and insurance were reviewed.

One (1) deficiency was cited during this annual inspection. Exit interview was conducted and a copy of this report, 809-D and appeals rights was provided.