Facility Evaluation Report

Licensing Program Analysts (LPAs) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Carolee Hazzard, Administrator for the facility, and was granted entrance. There are twenty-two (22) ambulatory clients who reside within the home.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices were observed. LPA asked administrator to submit the facility infection control plan to LPA if it is not on file currently.

· The facility is a two-story home located in a residential neighborhood that is licensed for a capacity of thirty (30) ambulatory clients between the ages of eighteen (18) through fifty-nine (59).It consists of seventeen (17) client bedrooms, a kitchen, a dining room, two (2) TV rooms, and five client bathrooms of which Restrooms #1 – 5 (R1 – R5) had hot water temperature readings of 113.1 Degrees F, 118.2 Degrees F, 71.4, 117.1 Degrees F, and Degrees F, and 117.7 Degrees F. R3’s hot water has a very low water temperature and does not produce hot water. The facility also contains a back patio area with multiple shaded areas, and a locked storage container that contains the facility’s emergency food supplies. LPA toured eight (8) client bedrooms and observed that one (1) client bedroom did not have a window screen, one (1) client bathroom’s shower is not currently operation, and one (1) client bedroom had a broken drawer. Additionally, there was a client bedroom that was missing a window screen as well.