Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos, conducted a required annual inspection using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Assistant Administrator Eloisa Talens and the purpose of the visit was discussed.

Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, office, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage cabinet for medications and sharps, (3) client rooms, (2) bathrooms for clients and one (1) live in staff room; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. A connected garage inaccessible to clients for storage, with washer and dryer. The residence is equipped with air conditioning. Accommodations : Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Client Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There are (2) cordless phone for residents use. Fire Extinguisher 1 and 2 fully charged and up to date Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates are stored at the other location until residents move in. Knives, cutlery and other sharps inaccessible to residents. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. Battery operated & working, all detectors tested and operational. (2) Fire extinguishers observed. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -115 degrees all around the home. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to residents. First aid kit observed. Postings: Required wall postings observed. Residents & Staff Files : LPA reviewed (3) of (3) Client medication records and files , as well as three (3) Staff Files . Emergency Disaster Plan observed. Plan of Operations Observed. Infection Control Plan Observed.

Inspection tool was completed and deficiency is being cited on 809-D page. Exit interview was conducted, and a copy of this report and appeal rights was provided and discussed.