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 Phillip Boncato, LVN for the facility, and explained the purpose. Administrator Susan Martinez was notified of the visit by phone.

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, office room, dining room, kitchen, a detached garage that contains extra supplies for the facility along with the washer and dryer, a backyard with a shaded area, and two (2) client restrooms of which had hot water temperature reading of 105.1 and 106.8 degrees Fahrenheit respectively. Knives and chemicals are are kept locked and inaccessible to the clients.

· 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 extinguisher kept in the facility. The facility was observed to be in good repair.