Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Luis DeLeon conducted the required annual inspection. LPAs met with Stephanie Kaplan and Rachel Tran discussed the purpose of today’s visit.

This home consists of (4) private client bedrooms, (2) bathrooms, living room, kitchen and dining area. This home is approved for (4) ambulatory clients.

LPA utilized the Compliance and Regulatory (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control plan in place.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms and carbon monoxide detector tested and operable. Fire extinguisher is located near the kitchen. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients.

Staffing : There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records-Training : LPA reviewed staff files for Staff #1 (S-1) and Staff #4 (S-4). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis.

Refer to LIC 809C for the continuation of this report.