Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with licensee, Persiveranda De Vera. The purpose of the visit was explained. The facility is licensed for (6) ambulatory clients, ages 18 to 59.

The facility consists of 3 client bedrooms, 2 staff rooms, 2 bathrooms, extra bathroom in the garage, living room, dining room, kitchen, and a garage. The outdoor has a shaded area with a table and chairs. Clients have shared bedrooms with appropriate furniture and storage space. There are extra linens and hygiene supplies. The fireplace is inaccessible to clients. Facility has operable smoke detectors and are interconnected. There are carbon monoxide detectors throughout the house. Knives and cleaning solutions are locked. The hot water temperature was measured between the required range of 105-120 degrees F. There are sufficient food supplies of 2 day perishable and a week of non-perishable items. The facility has the infection control plan. Staff are providing care and supervision to meet the clients' needs. Staff are all fingerprint cleared and associated to the facility. LPA reviewed (2) staff files and files are complete. Administrator's (Persiveranda De Vera) certificate expires on 11/14/27. S taff have First Aid certificates. Staff do not use any manual restraints on clients. There are no clients with a restricted or prohibited health condition. LPA reviewed (4) client files and their medications. All files contain the required documents. Medications are being administered as prescribed. The facility has the updated emergency and disaster plan and is conducting disaster drills.

No deficiencies were observed today. An exit interview was held and a copy of this report was given to the licensee.