Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Silvina Gomez and explained the reason for the reason.

The facility is licensed to served 14 ambulatory mentally ill clients between the ages of 18 to 59 years old. The facility is a two story home in a residential area and consist of; first floor: a living room, a kitchen, 2 client rooms, laundry area, 1 bathroom, an office with access to the basement, and a staff room. Second floor: 7 client bedrooms, and 2 bathrooms. A backyard, a front yard, a detach garage and a shed.

LPA conducted a tour with Silvina Gomez and observed the following:

Facility is in good repair indoor and outdoor. Living room/dining room sufficient seating area, clean, fireplace is covered. Kitchen is clean, knives are stored in a drawer and cleaning supplies under sink, medication cabinet was observed. Kitchen is inaccessible to the clients. Sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Refrigerators (2) and freezers (3) were observed in kitchen and garage without thermometers unable to check temperature. Client's rooms (8) were observed each with sufficient lighting, furniture, and bedding supplies. Bathrooms (3) were observed clean, in good repair, and water temperature was tested between 107.4-110.8 degrees F., which is within the required 105-120 degrees F. Laundry area was observed next to room #2. Detached garage is used to stored supplies. The backyard has a covered sitting area and there is a front porch with furniture. Carbon monoxide/ smoke detectors were tested and are in working condition. Fire extinguishers were lasted checked on 7/9/2022. Stairs and passageways were clear of debris.

LPA reviewed medication and files for 5 clients. Client #4(C4) does not have a physician's report signed by the physician. LPA reviewed 5 staff files, emergency disaster plan, infection control plan. Last fire drill was conducted on 6/7/23. Administrator certificate for Desiree Alvarado was reviewed for renewal #6004637735 exp. 12/16/23. HIV/TB training for administrator was not available for review. Staff training was reviewed no record of medication training available.

Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Silivina Gomez and a copy of this report, LIC 809D, and appeal rights were provided.