Facility Evaluation Report

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with caregivers Charlene Borla and Kim Lan Suhalim and explained the reason for the visit. The facility is licensed to serve 3 ambulatory and 1 non-ambulatory clients ages 18 to 59 years old, and a hospice waiver for one client. The facility is in a residential area. A tour of the single-story facility included the living room, dining area, kitchen, laundry room, 4 client bedrooms, 1 staff bedroom, 2 client bathrooms, 1 staff bathroom, attached garage, front yard, and backyard.

LPA Mora conducted the tour with Charlene Borla and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps were observed locked under the kitchen sink. Chemical and cleaning solutions are kept locked in the laundry room. The First Aid kit is kept locked in the medication closet in the hallway and it is fully stocked with all required items including a current manual. Clean towels and extra linen were observed in a hallway closet. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in the medication closet in the hallway. Client and staff files are kept locked in a cabinet located in the living room. All bedrooms have all required furniture, lighting, and bedding. All bathrooms were observed with shower mats. The water temperature was tested in all 3 bathrooms and measured at 113 degrees F, 107 degrees F and 107.5 degrees F, which is within the required 105-120 degrees F. Two fire extinguishers were observed in the kitchen and living room and are fully charged. Smoke detectors combined with carbon monoxide were observed throughout the facility and in each room and were operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction.