Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Post-Licensing visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Raymond William Zerde, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Jourdan Sanvictores arrived shortly thereafter. There is currently one (1) ambulatory client residing in the facility.

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 and Personal Protective Equipment (PPEs) were observed. LPA observed that the facility has a completed infection control plan.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of four (4) clients between the ages of eighteen (18) through fifty-nine (59), one (1) of which may be non-ambulatory. It consists of four (4) client bedrooms, a kitchen, a dining room, a living room, a laundry room, two (2) client restrooms of which Restroom #1 which had a hot water temperature reading of 106.2 Degrees Fahrenheit, and Restroom #2 had a hot water temperature of 105.4 Degrees Fahrenheit, and also a detached garage Knives along with the chemicals and cleaning supplies are kept locked and inaccessible to clients. A shaded outdoor area was available for clients in the backyard of the facility.