Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Imelda Sanchez, caregiver for the facility, and explained the purpose of the visit. Administrator Janice Harrison arrived shortly thereafter. There are four (4) ambulatory clients 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.

· Facility has an infection control plan on file.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of four (4) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of three (3) client bedrooms, one (1) staff bedroom, a living room, a dining room, a kitchen, an attached garage that contains the facility emergency food supply along with the washer and dryer, a backyard with a shaded area that also contains a locked shed with extra cleaning supplies, and a restroom which had a hot temperature reading of 106.2 Degrees Fahrenheit. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked in the laundry room of the facility.