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 Katheryn Jefferson, House Manager for the facility, and explained the purpose of the visit. Administrator Jenero Jefferson was notified of the visit by phone. There are four (4) ambulatory and two (2) non-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 five (5) ambulatory and one (1) non-ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of five (5) client bedrooms, a kitchen which also contains the washer and dryer for the facility, a living room, a dining room, a backyard that also contains a detached garage that serves as a storage area for the facility, and two (2) client restrooms which had hot water temperature readings of 118.2, 106.6 Degrees Fahrenheit respectively. Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients.