Facility Evaluation Report

Licensing Program Analyst (LPA) Lorena Casillas met with Administrator Monica Vartanian for an unannounced one (1) year Required visit for this facility. The facility is currently on a non-compliance plan.

LPA arrived at 09:30 am. There was no one in the facility. LPA Casillas called Administrator and was told that staff would meet with LPA in about 20 minutes. LPA was met by staff member. Administrator arrived shortly after. LPA informed the Administrator of the purpose of the visit. All clients were in their day programs or out in the community. Entrance interview conducted.

A tour of the physical plant was conducted with the Administrator at 10:45 am. The facility has five (5) bedrooms and two (2) bathrooms. It is currently occupied by four (4) clients. One (1) bedroom is designated for staff use only.

Infection control: LPA reviewed facility mitigation plan (approved on 01/30/21) to make sure licensee was following current infection control recommendations.

Kitchen : LPA conducted tour of the kitchen around 10:50 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed chemicals, all knives, and sharp objects in the locked kitchen cabinet under the sink. LPA observed the medications cabinet locked, along with the first aid kits. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be full and last serviced on 01/12/2024.