Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Staff, Katrina Porter. The reason for the visit was explained. The facility is licensed to serve 4 Developmentally Disabled adults ages 18 through 59, of which 2 may be non-ambulatory. There are currently 3 clients residing at the home.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The following domains were observed:

Infection Control: The facility has the Infection Control Plan and is continuing to follow appropriate hand hygiene. Staff are wearing gloves to assist clients during bathing. Staff are cleaning and disinfecting daily and more often for high touched surfaces.

Physical Plant & Environment Safety: The facility does not have any pool or bodies of water on the premises. There are 4 client bedrooms, 2 bathrooms, living room, family room, staff office, dining room, and kitchen. Each client bedroom has the appropriate furniture, storage space, and lighting. The laundry area is located in the staff office. Extra hygiene supplies were observed. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F.

Operational Requirements : The facility is operating within the fire clearance approval. Staff are providing care and supervision to meet the clients' needs and assisting in activities of daily living.

Food Service: There are sufficient food supplies of 2 day perishable and a week of non-perishable items observed. Foods are properly stored in the refrigerator to avoid contamination.

LPA will return another day to complete the remainder of the domains. An exit interview was held and a copy of this report was given to Staff Porter.