Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores and Ya Ting Yang conducted an unannounced annual visit with focus on the infection control domain, food review and medication review. LPAs met with Surrya Correa residential counselor and explained the reason for the visit. Administrator Marites Gacayan arrived 15 minutes later.

Facility is a single story home and it is licensed to served 6 ambulatory clients between the ages of 18 to 59 years old. Facility has no fences or large bodies of water. Facility has 3 client rooms, 1 staff room, 2 client bathrooms, a living room, a dinning room, a kitchen, an activity area, a basement inaccessible to clients, a shaded sitting in the front porch and a back yard.

Facility has sufficient food worth at least 2 days of perishables and 7 days of non-perishables. Sharps and chemical solutions are kept under lock in the kitchen. Living, dining, and activity area provide space for social distancing. All client bedrooms have all required furniture, sufficient lighting, and required bedding supplies. Bathrooms were observed to be in good condition and have grab bars, water temperature was tested as follow: bathroom #1(B1) tested at 109.8 degrees F., and bathroom #2(B2) tested at 110.6 degrees F. which is within the required 105-120 degrees F. Smoke detectors were tested and in working condition. Fire extinguisher was observed in a wall located in the activity area and last checked on 8/3/22. Facility's outdoor area is in good condition. PPE supplies were observed for 30 days, facility has signs and is following infection control recommendations. LPAs reviewed 6 clients medication and files and 3 staff files. Administrator certificate for Marites Gacayan was posted #6033708735 with an expiration date of 9/4/23.

No deficiencies were given during this visit.

Exit interview was conducted with Steven Castellanos Residential Counselor and a copy of this report was provided.