Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos, conducted a required Compliance and Regulatory Enforcement (CARE) Tool. LPA met with Administrator Cristina Obstaculo and the purpose of the visit was discussed.

Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage cabinet for medications and sharps, (2) client rooms, (2) bathrooms for clients , (1) Staff room; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for client use. There's a laundry area; with washer and dryer. The residence is equipped with Air conditioners around the home. Accommodations : Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Client Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is a cordless phone for client use. Fire Extinguishers observed Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates observed. Supply of perishables and non-perishables observed. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. All detectors operational. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -110 degrees all around the home. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to clients. First aid kit observed. Postings: Wall postings observed. Clients & Staff Files : LPA reviewed (4) of (4) client medication records and files , as well as four (4) Staff Files . Emergency Disaster Plan, Infection Control Plan, and Plan of Operation also observed and reviewed.

Inspection tool completed and no deficiencies are being cited. Exit Interview conducted and a copy of this report was provided