Facility Evaluation Report

On 11/19/2024 at 9:50 AM, Licensing Program Analysts (LPAs), Angelica Segovia and Gina Saucedo conducted an unannounced annual visit to the facility. Upon arrival LPA was greeted by the Administrator Dacia Von Buck. LPAs stated the reason for their visit.

LPA asked for census, staff, and resident files…. LPAs 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 three (3) bedrooms and three (3) bathrooms currently occupying three (3) residents. The garage was converted to a staff room with its own bathroom. The facility is fire cleared for four (4) ambulatory residents.

Required postings such as Emergency Disaster Plan, Administrator License, Personal Rights 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.

Living room observed to be neat, clean, and organized. Living room observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 68°F. Fire extinguisher located in the living room and dated 10/08/24. Fireplace observed to be covered inaccessible to residents.

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. Knives and sharps observed to be locked alongside medication in the living room inaccessible to residents. Cleaning solutions are kept locked in the laundry room located within the staff room alongside the kitchen and inaccessible to residents. Stove observed to be working and in proper condition. Additional required postings were observed aside the kitchen such as: Yes poster. Dining table located within the kitchen. Dining room observed to be neat, clean, and properly furnished. (continued on LIC 809-C)