Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Staff, Teliah Bertolini, and explained the reason for the visit. Administrator, Kalu Kwaka, arrived shortly after to assist with the visit. The facility is approved for 4 ambulatory only clients, ages 18 - 59. There are currently 3 clients residing at the home.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The single story facility consists of 4 client bedrooms, 1 staff room, 3 bathrooms, living room, dining room, and kitchen. Client bedrooms have the required furnishing and lighting. Bathrooms are in good condition. Extra hygiene supplies and linens were observed. There are smoke and carbon monoxide combo detectors located throughout the house. Knives and cleaning supplies are locked. Sufficient food supplies of perishable and nonperishable are observed. The water temperature was measured within the required range of 105-120 degrees F.

LPA reviewed 3 client files. Clients #1 and #2 were missing the medical assessment in their files. However, administrator provided proof that clients were seen by the physician but pending the medical assessments. Medications are centrally stored and reviewed for all the clients. No discrepancies were found. LPA reviewed 3 personnel files. The administrator's (Kalu Kwaka) certificate expired on 10/4/24. LPA verified that the renewal documents were received and is pending review by the administrator certification unit. Staff files have the required documents and current CPR & First Aid training.

The Emergency and Disaster Plan is current and reviewed by the administrator. A technical violation is issued for the emergency drills as the documentation is not complete, and the facility has not been conducting them at least quarterly.

Technical violations are issued today. An exit interview was held and a copy of this report was given to the staff.