Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to DSP staff Gladis Escobar. The facility is licensed as a level 4 Adult Residential Facility serving developmentally disabled residents 18-59 years.

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment.

Physical Plant/Environment Safety: The facility is a two-story home consisting of four (4) client bedrooms, (2) staff rooms, 3 bathrooms, kitchen, dining room, living room, family room, covered patio area, and attached garage with laundry area. Smoke and carbon monoxide detectors were tested and are operational. The facility one (1) fire extinguisher. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. Exit doors are free of any obstruction and there are no pools or large bodies of water.

Operational Requirements: Fire clearance is approved for four (4) ambulatory residents. Care and supervision to meet the clients needs was observed. Special equipment and supplies are used by residents. The Surety Bond expires 6/6/2025.

Staffing: A total of 4 staff members provide care and supervision to the clients.