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 Derry Sandajan, house manager for the facility, and explained the purpose of the visit.

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 three (3) client bedrooms, a staff room, a living room, dining room, a laundry area the contains the washer and dryer for the facility, kitchen, a detached garage that contains extra supplies for the facility, and two (2) client restrooms which had hot water temperature readings of 107.8 and 116.4 degrees Fahrenheit respectively. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked and inaccessible as well.

· 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 in the kitchen. Facility is in good overall repair.