Facility Evaluation Report

On 12/10/2024 at approximately 10:15 AM, Licensing Program (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. Upon arrival LPA was greeted by House-Manager Jessica Cruz. LPA stated the reason for the visit. House-Manager then called Administrator Jhomer Yuson who delegated House-Manager Cruz to oversee today’s visit and sign any documentation needed Shortly after Administration Yuson arrived..

LPA asked for census, staff, and client files. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying four (4) residents. The facility is fire cleared for four (4) ambulatory clients.

Required postings such as Emergency Disaster Plan, Yes Poster, and Rights of Individuals with Developmental Disabilities were located at the main entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

Both living room and dining room observed to be neat, clean, and organized. Both observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 68°F. Fire extinguisher located near kitchen dated 5/13/24. Staff reception area located in living room leading towards the backyard.

The kitchen observed to be fully stocked with two (2) days perishable and seven (7) days non-perishable food. Kitchen observed to be clean and inaccessible to pests. Cleaning solutions and knives/sharps are kept locked under kitchen. Stove observed to be working and in proper condition. Working telephone located in kitchen. (continued on LIC 809-C)