Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control, food review, and medication review. LPA met with Ramiro Martinez - Caregiver and explain the reason for the visit.

The facility is licensed to serve 4 non-ambulatory developmentally disable adults ages 18 to 59 years of age. Facility is a single home, in a residential neighborhood, with a kitchen, living room , dining room, 2 client bedrooms, a client bathroom, a staff bathroom, a laundry room, a detached garage, a front, and outdoor cover area, and back yard.

LPA conducted a tour of the facility and observed the following:

Kitchen - sharps, medication and disinfecting supplies were under lock in cabinet located in kitchen area. Refrigerator was empty, however perishables were observed in garage's refrigerator and non-perishables in pantry sufficient. Client's bathroom was observed and water temperature was measured at 112.1 degrees F., which is within the required 105-120 degrees F, a roach was observed in the wall. Client bedrooms #1 and #2 were observed and bed bug was observed in Client #1's bed and Client #3 bed. Smoke detector was tested and in working condition. Fire Extinguisher was observed and fully charged.

Facility is screening visitors, visitation rights were reviewed with staff. Screening is conducted with clients and staff. Signs are posted throughout the facility. Hand washing sign was not observed in client's bathroom, paper towels not available due to client's cognitive skills per staff. Staff have not been Fit tested for N95, PPE was observed but it is not sufficient for 30 days.

Exit interview was conducted with R. Martinez a copy provided.

Deficiencies were given under Title 22 Regulations:

*LPA Flores was experiencing technical difficulties during the visit . This report is a copy of the manual copy report provided which will be place on the facility's file with signature.*