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 Susan Martinez, 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 living room, dining room, kitchen, an attached garage that contains extra supplies along with the washer and dryer for the facility, a backyard with a shaded area, and two (2) client restrooms of which had a hot water temperature reading of 112.9 degrees Fahrenheit, and the second had a hot water temperature of 113.2 degrees Fahrenheit. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked and inaccessible as well.