Facility Evaluation Report

Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced annual inspection at the facility with focus on the infection control domain, food, and medication review. LPA Baptiste met with Josue Pompalopez, Day Program manager and explained the reason for the visit.

Facility is licensed to serve 3 Adults 18 Years and above, which 3 may be non- ambulatory. At the time of inspection facility census is 2. Facility is located in a residential neighborhood, single story house with a living room, dining room, kitchen w/ office area, 3 bedrooms, 2 bathrooms(1 for staff), laundry room, and garage. There are 2 clients residing in the home. All of the clients have PICA, and the staff to client ratio is 1:1 in home and 2:1 in the community.

LPA and Day Program manger toured the facility together and observed the kitchen with 2 day supply of perishables and 7 day supply of non perishables. The bedrooms have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition. LPA observed bedroom #2 chair cushion in disrepair. Bedroom #3 walls are scratch and worn out. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathrooms are clean, and showers have non-skid materials.The hot water temperature measured at 119.7 degrees F.