Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 08/24/2023 at 8:44 am. LPA was met by Licensee Jocelyn Lumauig explained the purpose of the visit. The facility is licensed serve developmentally disabled clients 18-59 years old. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020).

LPA OBSERVATIONS: Tour began at 9:06 am and was led licensee. The facility is a single-story building located in a residential area with three (3) client bedrooms, two (2) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to six (6) out of six (6) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to six (6) out of six (6) clients in care. LPA Ramirez observed a fully charger fire extinguisher nearby.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. LPA Ramirez observed fully charged fire extinguisher nearby.

Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 3: LPA Ramirez observed all resident bedrooms to contain the required linens, furnishings, and lighting. All client bedrooms are shared. Client bedroom #3 closet door was off the rails and not properly functioning for its original intended use. LPA Ramirez will issue deficiency.