Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Ann Hyde, administrator for the facility, and explained the purpose of the visit. There are two (2) non-ambulatory and one (1) ambulatory clients 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.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of three (3) non-ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of three (3) client bedrooms, a kitchen, a living room, a dining room, an attached garage that contains extra supplies for the facility along with the washer and dryer, a backyard with shaded area, and two (2) client restrooms which had a hot water temperature reading of 105.5 and 113.6 Degrees Fahrenheit respectively Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.