Facility Evaluation Report

Licensing Program Analyst (LPA) Noemi Galarza made an unannounced annual inspection visit. The purpose of the visit was explained to caregiver staff Flordeliza "Lourdes" Rosana. The facility is an Adult Residential Facility (ARF) that serves mentally disabled residents ages 59 and under.

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment.

Physical Plant/Environment Safety: The facility is a single story home consisting of 4 bedrooms [3 resident & 1 live-in staff room], 2 bathrooms, kitchen, dining room, living room, attached 2-car garage with laundry area, and outdoor patio area. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operational. The facility one (1) fire extinguisher. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. The facility has pet cats.

Operational Requirements: Fire clearance is approved for six (6) ambulatory residents. Care and supervision to meet the clients needs was observed. Special equipment and supplies are not used by residents. The facility does not handle resident monies; therefore a Surety Bond is not required.

Staffing: A total of 3 staff members provide care and supervision to the clients.