Facility Evaluation Report

On 10/28/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with caregiver Lourdes Balolong and explained the purpose of today’s visit. The facility is licensed to operate for six (6) ambulatory clients between the ages of 18 through 59.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) client bedrooms, one (1) office, one (1) staff room, three (3) bathrooms, two (2) living areas, one (1) dining area, laundry area, kitchen, a two-car garage and outside shaded patio area.

At around 9:20 AM, LPA Montoya and Balolong toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature in two client bathrooms adjacent to each other were 124.6 degree F and 124.7 degree F. A comfortable temperature of 75 degrees was maintained in the facility.

LPA Montoya observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food supply. There are three (3) fully charged fire extinguishers serviced on 1/27/2023. Smoke detectors and carbon monoxide were operable. A review of Medication Records Administration (MARs) was conducted and was observed to be maintained in order and accurate. Several landline phones were available and operable. The last Fire Drill was conducted on 10/27/2023. Administrator's Certificate expires on 2/25/2025.