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 Susan Martinez, administrator for the facility, 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 and Personal Protective Equipment (PPEs) 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) non-ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of two (2) shared and two (2) single client bedrooms, a kitchen, a dining room, a detached garage the contains the facility’s washer and dryer machines, and two (2) client restrooms of which Restroom #1 which had a hot water temperature reading of 105.0 Degrees Fahrenheit, and Restroom #2 had a hot water temperature of 104.9 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.

· The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no pools are or bodies of water accessible to the clients. Fire alarm system is operational. The facility has two (2) fully charged fire extinguishers that are kept throughout the facility. Cleaning supplies and toxic substances are kept locked and inaccessible to clients.