Facility Evaluation Report

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA Flores met with Carlors Garcia Direct Support Staff(DS)P) and explained the reason for the visit. Alicia Walters Administrator arrived 15 minutes later.

The facility is licensed to serve four (4) Developmentally Disabled Clients ages 18 - 59 years. The facility is approved for two (2) Non-Ambulatory Clients. The facility is located in a residential area. A tour of the single-story facility includes: Two (2) client bedrooms, two (2) bathrooms, living room, kitchen, dining area, and indoor/outdoor activity areas.

LPA Flores conducted a tour of the facility with Heidy Flores DSP and observed the following;

Facility's living room has sufficient sitting space, a fireplace was observed with an item blocking it. A video surveillance system was observed in the common areas. Kitchen was observed clean and in working condition. Food supplies were observed sufficient for at least (2) days of perishables and (7) days of non-perishables. Medication and sharps cabinet was observed next to the dishwasher and lock. Passage way to the backyard was observed with a lock cabinet for cleaning supplies, a sink accessible to the clients water temperature was measured at 132.4 degrees F. Bathroom #1(B1) was observed in working condition water temperature was tested and measured at 128.3 degrees F., which is not within the required 105-120 degrees F. Bedroom #1(BR1) and Bedroom #2(BR2) were observed to have the required furniture and bedding supplies. BR1 was observed to have a lamp sufficient for one client and the light fixture in the ceiling was not working. BR2 half bed rails were observed for client #2(C2) no physician's request was observed in client's file. Front porch and backyard have shaded sitting area available. Smoke/Carbon monoxide detectors were tested and not working in BR1 and BR2. Fire extinguisher was observed and last checked on 4/13/23. Medication and files were checked for 3 clients and 5 staff files were checked. Emergency disaster plan was reviewed, last fire drill was conducted on 4/11/23. Administrator certificate was observed for Alicia Walters #6022731735 exp: 10/2/22. Documents have been submitted for renewal.

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