Facility Evaluation Report

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Administrator, Anahi Murillo Serrano, and explained the purpose for the visit.

During today's visit, LPA Maldonado conducted a tour of the physical plant with Administrator, observed the facility food supplies, reviewed (5) client medications, (5) client files, (5) staff files, and conducted interviews with (5) staff, and attempted interviews with (4) clients. The facility is a single-story home, operating as an Adult Residential Facility for Persons with Special Health Needs. It is licensed to serve (5) adults, ages 18-59. There is a fire clearance approved for (5) bedridden adults. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review.

LPA observed all client bedrooms to have the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms and (1) half bathroom in the home- (1) bathroom is designated for client use and accommodates non-ambulatory clients. It is equipped with required grab bars and non-skid mats. The hot water was tested and measured at 99.6*F, which is not within the required temperature of 105*F-120*F. Food supplies was observed and was sufficient as required, considering client's modified/special diets. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to clients in care. The last fire drill was conducted on 04/04/2024. (5) client files and (5) staff files were reviewed and observed to be complete with all required documentation. (4) client medications were reviewed and were observed to be documented properly and given as prescribed. (2) of (5) clients currently have restricted health conditions, for which the facility maintains and follows all client a written Restricted Health Condition Care Plan, as part of the client's Needs and Services Plans.

During today's visit, deficiencies were observed and will be cited on the LIC9099-D.

An exit interview was conducted and a copy of this report and appeal rights were provided.