Facility Evaluation Report

Licensing Program Analysts (LPAs) Erik Zaragoza and Gabriela Castro conducted an unannounced Required 1-year visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Annelyn Antonio, caregiver for the facility, and explained the purpose of the visit. Administrator Ruvy Pelesasa arrived shortly thereafter. There are three (3) ambulatory clients and one (1) non-ambulatory client residing in the facility.

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 were observed. LPA observed that the facility has a completed infection control plan.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of three (3) ambulatory clients and one (1) non-ambulatory client between the ages of eighteen (18) through fifty-nine (59). It consists of four (4) client bedrooms, a kitchen, two (2) living rooms, a dining room, an attached garage that contains extra supplies along with the washer and dryer for the facility, a backyard with shaded area with a locked storage shed that contains tools, and 2 client restrooms which had a hot water temperature reading of 116.6 and 116.3 Degrees Fahrenheit respectively. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.