Facility Evaluation Report

Licensing Program Analysts (LPAs) Erik Zaragoza and Daniel Konishi conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Joel Garcia, Direct Support Staff (DSP) of the facility, and was granted entrance. House Manager Derry Sandajan shortly thereafter. There are four (4) ambulatory clients residing within the home.

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 had 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) ambulatory clients between the ages of eighteen (18) through fifty-nine (59).It consists of three (3) client bedrooms, a kitchen, a dining room, living room, and two client bathrooms of which Restroom #1 (R1) had a hot water temperature reading measured at 115.7 Degrees F, and Restroom #2 (R2) had a hot water temperature reading at 107.8 Degrees F, and a detached garage which contains the emergency food supplies for the facility. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked in the laundry room of the facility. A shaded outdoor area was currently not available for the clients.