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 Archie Buenaventura, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator of the facility Cristina Obstacula arrived shortly thereafter. There are three (3) 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.

· 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) ambulatory clients between the ages of eighteen (18) through fifty-nine (59). It consists of two (2) shared client bedrooms, a kitchen, a living room, a dining room, a laundry area, a staff room, two (2) client restrooms of which Restroom #1 which had a hot water temperature reading of 109.5 Degrees Fahrenheit, and Restroom #2 had a hot water temperature of 110.6 Degrees Fahrenheit, along with a detached garage that contains the facility’s emergency food supply. 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.