Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Norma Orbita, House Manager for the facility, and explained the purpose of the visit. Administrator Michelle Puno arrived shortly thereafter. There are five (5) ambulatory clients residing in the facility.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices were observed. LPA observed that the facility has a completed infection control plan.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of six (6) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of two (2) shared and two (2) single client bedrooms, one (1) staff bedroom a kitchen, a dining room, a living room, an attached garage that contains the facility’s laundry area, and two (2) client restrooms of which Restroom #1 which had a hot water temperature reading of 106.7 Degrees Fahrenheit, and Restroom #2 had a hot water temperature of 105.9 Degrees Fahrenheit. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients. A shaded outdoor area was available for clients in the backyard of the facility.