Facility Evaluation Report

Licensing Program Analyst (LPA) S Vaid made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Care Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA met with House Manager Loridelle Jamero and explained the purpose for the visit.

The facility is licensed to serve (3) developmentally disabled adults, ages 18-59, of which (2) may be non-ambulatory.

The facility is a single-story home, located in a residential area. The home consists of a living room, (3) client bedrooms, (2) client bathrooms, a kitchen, dining room, attached garage, and shaded patio.

During today's visit, LPA Vaid obtained a copy of the client and staff roster and conducted a tour of the physical plant with assistance of DSP, Loridelle Jamero. The following was observed:

Single entry point for universal entry screening. Mitigation Plan and Infection Control Plan approved and in place. Sufficient PPE stored for 30-days and readily available for use, throughout the home and stored in the garage.

Physical plant inside and outside is clean, sanitary and in good repair. All walkways and pathways observed to be free of obstruction/hazards. All client bedrooms had the required furniture and the bedding had the required linens. Additional linens were observed in a linen closet in the hallway, inspected and in good repair. Cleaning supplies and toxins were observed locked and inaccessible in a close in the hallway and in the garage. Each bathroom was equipped with a toilet, shower, and wash basin. All operational and in good repair. The water temperature was tested and measured at 107.4*F in bathroom# 1 and 110.2*F in bathroom# 2 and 109.6* F in the kitchen is in compliance. Sharps and knives were stored inaccessible in a kitchen drawer next to the dishwasher. Food supplies was inspected and observed to have the required 2-day perishables and 7-day non-perishables- food was sufficient for amount of clients in care. The first aid kit was inspected and had the required items/First Aid Manual available. The facility had all required posting posted throughout.