Facility Evaluation Report

Licensing Program Analysts (LPAs) Erik Zaragoza 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 Rosy Zavala, Direct Support Staff (DSP) of the facility, and was granted entrance. Administrator Venateswara Vankina arrived shortly thereafter. There are three (3) 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) clients between the ages of eighteen (18) through fifty-nine (59). It consists of four (4) 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 106.7 Degrees F, and Restroom #2 (R2) had a hot water temperature reading at 109.5 Degrees F, a shaded outdoor patio area in the backyard which also contains the facility's washer and dryer machines, and a detached garage which contains the emergency food supplies for the facility. Knives are kept locked in a closet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked in a kitchen cabinet.