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 Ernestina Jimenez, caregiver for the facility, and explained the purpose of the visit. Administrator Edgar Hernandez arrived shortly thereafter.

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. It consists of two (2) client bedrooms, a living room, dining room, kitchen, a detached garage that contains extra supplies for the facility, a den, a washer and dryer located near the kitchen of the facility, and a two (2) client restroom which had a hot water temperature reading of 112.8 and 111.2 degrees Fahrenheit respectively. Knives are kept locked in a cabinet in the kitchen of the facility, and the chemicals and cleaning supplies are kept locked and inaccessible as well.