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, and explained the purpose of the visit. There are four (4) non-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 four (4) bedridden clients between the ages of eighteen (18) through fifty-nine (59). It consists of one (1) shared and two (2) individual client bedrooms, a kitchen, an office, a staff room, a living room, a dining room, a detached garage that contains the washer and dryers of the facility, a backyard with shaded, and two (2) client restrooms which had hot water temperature readings of 107.7 and 105 Degrees Fahrenheit. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.