Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA arrived unannounced and met with Staff, Sally Balto. The facility is licensed for (6) ambulatory adults, ages 18 - 59.

LPA toured the facility, reviewed files, and conducted interviews. The following were observed:

The facility does not have any pools or bodies of water on the premises. There are 4 client bedrooms, 1 staff room, 2 bathrooms, living room, kitchen, staff/client activity area, and attached garage. The clients bedrooms have the required furniture and storage space. Bedroom #2's window has an opening below the window frame and a hole was observed on the window screen. There are extra linens and hygiene supplies. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives and cleaning solutions are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The facility is operating within the fire clearance approval. Staff are continuing to follow their infection control plan. LPA observed sufficient food supplies of 2 day perishable and a week of non-perishable items. Foods are properly stored in the refrigerator to avoid contamination.

LPA reviewed records for 3 Staff and 6 Clients. Staff are all fingerprint cleared and associated to the facility. Staff and Client files all have the required documents. Staff have current first aid and CPR training. They do not utilize manual restraints at the home. Medications are centrally stored and locked in the hallway storage room. LPA reviewed medications for all 6 clients and there was a discrepancy noted for Client #3. The facility has the updated emergency and disaster plan and is conducting monthly fire drills and disaster drills.

Deficiencies are issued on the LIC809D page. An exit interview was held and a copy of this report was given to the staff.