Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with DSP Kyasha Spencer, and explained the reason for the visit. The facility is licensed for (4) ambulatory clients, ages 18 - 59.

LPA toured the facility and inspected the following domains:

Infection Control: Staff are continuing to clean and disinfect the facility at least once a day and more often for high touched surfaces.

Physical Plant & Environment Safety: There are 3 client bedrooms, 2 bathrooms, open living room, dining area and kitchen, and an attached garage. Each client bedroom has the required furniture and bedding. Extra hygiene supplies and linens are observed. There is no swimming pool. The backyard has a table and chairs for client to use. Smoke detectors are interconnected and the carbon monoxide is in the hallway. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature in bedroom #3 was measured at 128.3 degrees F, which is over the required range.

Operational Requirements: The facility is operating within the approved fire clearance. Staff are providing the care and supervision as necessary to meet the clients' needs.

Food Service: There are sufficient food supplies of 2 day perishable and a week of non-perishable. The kitchen is clean and free of pests.

LPA checked the medications for all 4 clients and they are being administered as prescribed by the physician.

A deficiency was issued on the LIC809D. An exit interview was held and a copy of this report was given to the staff.