Facility Evaluation Report

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Imelda Jonson - caregiver and explained the reason for the visit.

Facility is a two-story home licensed to serve 9 adults between the ages of 18 to 59 years old, ambulatory only. Facility has 5 client bedrooms, 2 client bathrooms, 1 staff bedroom with a private staff bathroom, a kitchen, laundry, living room and dining/office room and a detached garage.

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

Facility's outside is in good condition, no large bodies of water observed and has a front porch or backyard. A shaded sitting area is in the backyard. Facility has sufficient non-perishable (2 days) and perishable (7 days) foods. Kitchen's refrigerator was observed and thermometer read at 60 degrees F, and freezer's at 0 degrees. Living room/dining room/kitchen and laundry room are in good repair. Client bedrooms (5) were observed, each has the required furniture and bedding supplies. Bedroom #5 was observed with a hole of about 2x2 inches in the wall covered with clear tape. Bathrooms (2) were observed in good repair and water temperature was tested between 116-120 degrees F., which is within the required 105-120 degrees F. Cleaning supplies and sharps were observed locked in kitchen's cabinet. Additional food supplies were observed in the garage. Medication is locked inside caregiver's bedroom. LPA reviewed medication, P&I money, and files for 5 clients, and 5 staff files. Emergency disaster plan LIC610D(10/03) last updated on 8/19/20. Last fire drill was conducted on 5/31/23. Fire extinguishers were last checked on 9/28/22. Smoke/Carbon monoxide detectors were tested and in working condition.

Administrator certificate was observed for Carol Liess #6025209735 exp. date: 2/25/23, department received renewal 5/4/23 pending renewal. HIV/TB training on file is dated 10/8/99 per requirements it should be updated every two years.

Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Katrin Silvestro Services Coordinator and a copy of this report, LIC 809D and appeal rights were provided.