Facility Evaluation Report

Licensing Program Analyst (LPA)s Mary Flores and Christian Gutierrez conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Larissa Cantos and explained the reason for the visit.

Facility is licensed to serve 8 ambulatory clients between the ages of 18-59 years old. Facility is a two story house with 4 client bedrooms, 2 clients bathroom, 1 live-in staff bedroom, 1 staff bathroom, living room, dining room, kitchen, an office, detached garage, front and back porch with laundry room area, and a shaded outdoor sitting area.

LPAs conducted a tour of the facility with Larissa Cantos and observed the following:

Facility was observed in good repair inside and outside. Living room was observed to have a fireplace that is cover. Dining was observed as their activity area with supplies and sufficient sitting area. Kitchen was observed clean, food supplies were observed LPAs sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables. Sharps were observed locked in a drawer. Refrigerators and freezers were observed. Freezers were observed at 20 degrees F., which is not the required zero or under degrees F. Cleaning supplies were observed locked in the storage by garage. Each room (4) had sufficient lighting, required furniture, and bedding supplies. Bathrooms (2) are in working condition, were observed with skid mats and grab bars (home service 60 and over clients), water temperature was tested between 108.3-113.8 degrees F., which is within the required 105-120 degrees F. Carbon monoxide/Smog detectors were tested and in working condition. No large bodies of water were observed. Backyard patio has a shaded sitting area. LPAs did not observed evacuation chairs in each stairwell.

LPAs reviewed 5 client files and medication. P&I money for 2 clients was reviewed. Five staff files were reviewed and emergency annual training was not observed. Infection control plan and emergency disaster plan were reviewed. Emergency disaster plan (version 10/03) was last updated on 8/30/19 and is missing some of the components do not meet the most current emergency disaster plan.(CONTINUED ON LIC 809C)