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 Michelle Puno, administrator for the facility, and explained the purpose of the visit.

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.

· Facility has an infection control plan on file.

· The facility is a single-story home located in a residential neighborhood. It consists of four (4) client bedrooms, a staff room, one (1) vacant bedroom, a living room, dining room, kitchen, an garage that contains extra supplies for the facility, a laundry room that contains the chemicals that are locked for the facility, two (2) client restrooms which had hot water temperature readings of 105.3 and 105.7 degrees Fahrenheit respectively. Knives are kept locked in a cabinet in the kitchen of the facility.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no pools or bodies of water accessible to the clients. Fire alarm system and carbon monoxide detectors are operational. The facility has a fully charged fire extinguishers kept in the facility. The facility was observed to be in good repair.