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 Rudy Santos, Direct Support Staff for the facility, and explained the purpose of the visit. House Manager Derry Sandajan arrived shortly thereafter. There are four (4) 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) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of three (3) client bedrooms, a kitchen, a living room, a dining room, a staff room, a laundry area that contains the facility’s washer and dryer, a detached garage that contains extra supplies for the facility along with its emergency kits, a backyard with shaded area, and two (2) client restrooms which had a hot water temperature reading of 106.3 and 114.4 Degrees Fahrenheit respectively. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.