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 Maemelyne Gonzalez, Licensing Vocational Nurse for the facility, and explained the purpose of the visit. Administrator Susan Martinez arrived shortly thereafter. There is one (1) bedridden and two (2) 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.

· 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 four (4) client bedrooms, a kitchen, a living room, a dining room, an attached garage that contains extra supplies along with the washer and dryer for the facility, and two (2) restrooms of which Restroom #1 had a hot water temperature reading of 106.8 Degrees Fahrenheit and Restroom #2 had a hot water temperature reading of 106.5 Degrees Fahrenheit. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.