Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent unannounced annual continuation inspection. LPA met with Francis Ukomadu, Direct Support Professional I & II (DSP I & II) and Yolanda Maciel, Direct Care Staff and explained the purpose of the visit. Staff notified Saundra Sahagun, Administrator by telephone that CC Licensing personnel is at the facility. Administrator arrived at 2:20pm to assist LPA with the inspection. During today's continuation visit, LPA utilized the Compliance and Regulatory Enforcement (CARE) tools and reviewed files and inspected the following domains:

Personnel Records/Staff Training: Reviewed files for two (2) staff. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Administrator certificate expired on 04/04/2024 and has submitted the renewal in May 2024. Administrator has a valid HIV/AIDS training proof at the time of visit.

Client Rights-Information: Client personal rights are posted. Per Staff, facility provides internet services to all clients and have access to the facility phone. Staff stated that none of the clients have their own personal cell phone and (3) clients have IPad/tablet. LPA conducted interviews with (1) client, the other (2) clients are non-verbal.

Food Service: There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept cleaned and stored properly.

Client Records-Incident Reports: LPA reviewed Client files for C1 through C3. Client files are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights observed.

Health Related Services: The medications are centrally stored and in their original containers. Medications were reviewed for C1-C3 to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. First aid supplies are maintained and readily available in the facility.

Incidental Medical Services: None of the clients at this home has a restricted health condition.

Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan. Emergency Intervention: Not applicable.

The required 1-yr visit is complete. Per Title 22 Regulations, there were no deficiencies observed during the initial and continuation visit.

Exit interview was held and a copy of this report was provided to the Administrator, Saundra Sahagun.