Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA met with Administrator, Memer Dellosa, and explained the purpose of the visit.

LPA conducted the following domains during the visit today:

Staffing : There is sufficient staffing at the facility. There is (1) awake staff in the overnight shift. Staff have fingerprint clearance and associated to the facility. Personnel Records-Training : Staff files are maintained at the facility. Administrator (Memer Dellosa) certificate expires on 10/18/2024. Staff have current CPR/first aid certificates and sufficient on-going training to meet the annual requirement. LPA reviewed (3) personnel files which contain all their required documentation. Client Rights - Information: Clients are provided with internet access devices. Client Records - Incident Reports: LPA reviewed (3) Client files. The files include the admission agreement, medical assessment with TB lab results, current Individual Program Plans, and consent forms. There are no clients with a restricted health condition and are all ambulatory. Health-Related Services: The medications are centrally stored and locked. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all 3 clients and they are being administered as prescribed by the physician. Incidental Medical & Dental: There are no clients who require health services or have a health condition that need to be monitored more carefully. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Staff are provided training on the emergency procedures and know where the utility shutoff valves are located. Facility is conducting monthly disaster drills. Emergency Intervention: The staff do not need to use manual restraint on the clients at this home but have CPI training.

There are no deficiencies issued today. An exit interview was conducted and a copy of this report was given to the administrator.