Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Persiveranda De Vera and the purpose of the visit was discussed. The facility is licensed for 6 ambulatory adults, ages 18 through 59.

The following 12 (CARE) tool domains were utilized during the inspection:

Infection Control: Staff are using appropriate hand hygiene and wearing gloves when deemed necessary. Facility has an Infection Control Plan in place. LPA collected a copy

Operational Requirements: Facility is licensed to serve, and has fire clearance for, six (6) ambulatory clients. Staff are adhering to operational requirements.

Physical Plant & Environment Safety: The facility is a single-story home located in a residential area. A tour of the facility includes: Living room, dining room, kitchen, 3 client bedrooms, 2 staff bedrooms, 2 bathrooms, front yard/back yard, covered patio and an attached garage/laundry . LPA observed sufficient space in the outdoor areas for clients use. There are no pools or bodies of water on the premises. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. There are no firearms or weapons stored at the facility. Water temperature measured within Title 22 regulations of 105-120 degrees.

Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed three (3) staff files and they have current First Aid/CPR certification. Staff have their Health Screening, fingerprint clearance, and criminal record statements on file. Staff training's reviewed. Administrators file was reviewed.