Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Lolita Reyes and explained the reason for the visit.

The facility is licensed to served 6 ambulatory adults ages 18 through 59, of which 2 may be non-ambulatory. Facility is located in a residential neighborhood and consist of a single home with 5 client bedrooms, 2 bathrooms, a living/dining room, kitchen, laundry area, storage area, an office, a front yard, and a back yard.

LPA Flores conducted a tour of the facility with Lolita Reyes and observed the following:

Facility is in good repair indoor and outdoor. Kitchen was observed clean. Food supplies were observed for at least 2 days worth of perishables and 7 days of non-perishables. Cleaning supplies and sharps were observed inaccessible to the clients during the visit. Medication cabinet was locked during the visit. Storage area hold additional food supplies and other supplies. Laundry area was clean and free of chemicals. Each client bedroom was observed clean with sufficient lighting, bedding supplies, and the required furniture. Bedroom #2 was observed to have a black burned outlet. Two bathrooms were observed clean, in good repair, and water temperature was tested between 107.6 - 107.8 degrees F., which is within the required 105-120 degrees F. Carbon Monoxide/Smoke detectors were tested and are in working condition. Fire extinguisher was observed. There are no large bodies of water in this home. Backyard has a covered seating area.

LPA reviewed 5 clients files, medication, P&I money, and 5 staff files.

A review of the facility's infection control plan, and emergency disaster plan was conducted.

A deficiency is noted during this visit under Title 22 Regulations.

Exit interview was conducted with Alvin Capanzana acting administrator and a copy of this report, LIC 809D, and appeal rights were provided.